Hemlata Rai's "The return of the parasites" (#105) is appreciated for its attempt to explain the situation of malaria in Nepal. A few clarifications: the resurgence of drug-resistant malaria is a global phenomenon rather than an isolated event in Nepal, and its incidence is higher than what is reported by the government. This is mainly due to faulty surveillance mechanisms and poorly conducted laboratory procedures. The laboratory diagnosis of malaria is one of the simplest lab procedures, which requires neither state-of-the-art laboratory equipment nor advanced skills. All it needs is a light microscope, glass slides, Geimsa stain and tap water, with lots of motivation and time on the laboratory technician's part. As this is tedious and not financially rewarding, laboratory technicians are often dissuaded from conducting the procedure properly.

There have also been claims that malaria is increasingly being mistaken for Japanese encephalitis and so forth. In an era of evidence-based medicine, it would be much wiser to bring these claims to the debate and scrutiny of appropriate scientific forums before dispatching them as headlines in daily newspapers and tabloids. Anecdotal reports of malaria in the Nepali highlands (possibly in people who have travelled to endemic areas) must be distinguished from malaria resulting from indigenous transmission. Any conclusions drawn in this regard without proper longitudinal studies would be but premature.

Achyut Bhattarai,
Tangal