Title Page, Copyright, Dedication

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pp. 1-6

Contents

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pp. vii-8

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Preface

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pp. ix-xii

I am privileged to spend much of my time teaching and performing research in one of America’s foremost liberal arts colleges. I work with some of the brightest young students and some of the most talented biologists in the world. Much of my work is molecular biology, and I am amazed at how many times I get...

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Acknowledgments

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pp. xiii-xv

As my ideas took so long to crystallize into a book, it is impossible to acknowledge everyone whose comments, work, questions, and criticisms helped to produce the manuscript. I cannot but begin by thanking the health workers and scientists who are devoted to addressing infectious diseases in Africa. Many...

Abbreviations

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pp. xvii-18

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Introduction

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pp. 1-8

On a typical day at a health center in southwestern Nigeria, patients arrive long before the outpatient clinic opens. Most patients are infants or young children, strapped to the backs or held to the breasts of tired young mothers. Babies wear pretty cotton print outfits and rubber shoes or slippers, perhaps with white socks....

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1. The Power of Sight

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pp. 9-20

Anyone who has lived in malaria-endemic Africa has probably been a victim of the febrile diagnostic quandary, whether they know it or not. Personally, I have only vague recollections of the month of my final examinations for the bachelor’s degree at a Nigerian university. During reading period and exam weeks, my...

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2. Fever: Is It Malaria?

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pp. 21-37

The untimely death of Ogonim, the only child of the protagonist in Flora Nwapa’s epic novel Efuru, illustrates the consequences of failing to intervene quickly and effectively in fevers in malarious areas.1 Set in an Ibo town close to the Niger River in the early twentieth century, the text depicts the time when Western...

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3. Fever: Beyond Malaria

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pp. 38-49

Over a century and a half later, Henle’s eloquent description of the problem of confounding causes with effects remains applicable to the case of fevers in Africa. Despite scientific advances in the understanding of specific febrile illnesses, the treatment of fever continues to be based on empirical symptoms rather than...

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4. Drug Resistance

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pp. 50-64

Between 1990 and 2000, childhood deaths from malaria rose across Africa. Substantial advances in the treatment and prevention of other major killers of children, particularly oral rehydration therapy for diarrhea and vaccination against pneumonia bacteria,1 were offset by increases in malaria mortality. Although...

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5. Viral Hemorrhagic Fevers

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pp. 65-90

Only the wealthiest African patrons of allopathic medicine can afford to have personal physicians. The rest visit overburdened and understaffed health institutions, usually only when they are very young, pregnant, or severely ill. Patients do not necessarily visit the same institution each time, so that whatever facets of...

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6. Detecting Covert Infection ahead of the Final Diagnosis

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pp. 91-105

One of the pathologist Segun Ojo’s lifelong gripes has been the steady decline of medical laboratory science in Nigeria. Aware of the pressing need to train a generation of competent laboratory diagnosticians and researchers, he committed himself to building the expertise necessary to remedy diagnostic insufficiency...

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7. Diagnostic Certainty and Disease Control

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pp. 106-124

Despite media images that portray Africa as a disease-plagued continent and the concerns expressed, even by medical and public health experts, that in Africa health targets are often set but rarely achieved,1 some well-planned and properly implemented programs have met with success. Smallpox was eradicated...

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8. Origins and Outlook of Diagnostic Insufficiency in Africa

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pp. 125-140

The chief nursing officer at Ikeja General Hospital, who was always addressed as “Chief Matron,” spoke for ten minutes at a staff orientation in 1990. During her talk, she pleaded that new doctors enter at least a presumptive diagnosis into patient case notes after examination, along with their initial prescription: “A...

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Conclusion: The Feasibility of Laboratory Diagnosis in African Settings

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pp. 141-161

In May 2009, the Annals of Tropical Medicine and Hygiene published an audit of diagnostic services in the Tanga region of Tanzania. The audit was performed roughly five years after Tanzania had committed to an ambitious health care reform program, which commendably included a stated intention of ensuring access...

Notes

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pp. 163-186

Works Cited

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pp. 187-211

Index

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pp. 213-222