A. Answer number 2 is correct. Hypoglycaemia is a serious complication which may be aggravated by the effects of quinine. It is easy to diagnose with a bedside “stix” test and is reversed with intravenous glucose. Complicated malaria is usually accompanied by a haemoglobin of less than 5g/dl.
B. Answer number 2 is correct. Meningitis remains a possibility in any patient with impaired consciousness. Artesunate intravenously may reduce mortality from malaria by about one third compared to quinine. Diclofenac may be nephrotoxic. ALL members of the medical team are responsible for the close observation of our patients.
C. Only answer number 2 is true. Urbanised Africans have equal cardiovascular risks compared with Western populations. Cancer deaths in Africa are 600,000 each year and a third are preventable.
D. Only answer number 3 is true. 90% of patients with haemorrhagic stroke have hypertension. Reduction in salt intake plays an important part in the management of hypertension in Africa as it does everywhere. There is some evidence that Black Africans are more sensitive than white people to the effects of reducing salt in their diets. Obesity has increased in Africa especially in urban populations.
E. Only answer number 1 is true. 95% of the world’s cases of guinea worm infestation occur in South Sudan and Ghana. Boiling or filtering drinking water is important. Zinc supplements are helpful in the management of diarrhoea.