Clinical diagnosis of malaria and the risk of chloroquine self‐medication in rural health centres in Burkina Faso

Abstract

Summaryobjective To assess the quality of healthcare workers' performance with regard to malaria diagnosis and treatment and to assess patients' self-medication with chloroquine (CQ) before and after presentation at a health centre.methods In the rainy season 2004, in five rural dispensaries in Burkina Faso, we observed 1101 general outpatient consultations and re-examined all these patients. CQ whole blood concentrations of confirmed malaria cases were measured before and after treatment.results The clinical diagnosis based on fever and ⁄ or a history of fever had a sensitivity of 75% and a specificity of 41% when compared to confirmed malaria (defined as an axillary temperature of ‡37.5°C and ⁄ or a history of fever and parasites of any density in the blood smear). Few febrile children under 5 years of age were assessed for other diseases than malaria such as pneumonia. No antimalarial was prescribed for 1.3% of patients with the clinical diagnosis malaria and for 24% of confirmed cases, while 2% received an antimalarial drug prescription without the corresponding clinical diagnosis. CQ was overdosed in 22% of the prescriptions. Before and 2 weeks after consultation, 25% and 46% respectively of the patients with confirmed malaria had potentially toxic CQ concentrations.conclusion As long as artemisinin-based combination therapy remains unavailable or unaffordable for most people in rural areas of Burkina Faso, self-medication with and prescription of CQ are likely to continue despite increasing resistance. Apart from considering more pragmatic first-line regimens for malaria treatment such as the combination of sulfadoxine-pyrimethamine with amodiaquine, more and better training on careful clinical management of febrile children including an appropriate consideration of other illnesses than malaria should be made available in the frame of the IMCI initiative in subSaharan Africa.

Socioeconomic Inequalities in Access to Health Care: Examining the Case of Burkina Faso

“…It is very likely that accessing care at home may have been self-medication, which is widespread in this part of the globe. [79][80][81][82] Additionally, a good number of people patronise the traditional healing homes or herbalists. [83][84][85][86][87][88][89][90] These local healers charge less than orthodox medical practitioners and are considered more knowledgeable for certain ailments.…”

Patients’ perception and satisfaction on quality of laboratory malaria diagnostic service in Amhara Regional State, North West Ethiopia

“…Malaria is a major global health problem [1]. According to the latest estimates, 198 million cases of malaria occurred globally in 2013 and the disease led to 584, 000 deaths.…”

“…Correct diagnosis and effective treatment are among the main strategies in the fight against malaria. A diagnosis based on clinical symptoms alone has very low specificity and contributes to an increase in non-malaria morbidity and mortality, the misuse of anti-malarial drugs, increased costs to the health services and patient dissatisfaction [1]. …”

Factoring Quality Laboratory Diagnosis into the Malaria Control Agenda for Sub-Saharan Africa

“…26 Provision of free or reduced-cost malaria laboratory testing and ACTs for positive cases needs to be widespread enough within a country to encourage individuals who would otherwise not seek medical care to use health facilities for assessment of symptoms suggestive of malaria and increase the proportion of suspected malaria cases that are parasitologically confirmed. These services could reduce instances where individuals incorrectly self-medicate with antimalarials without appropriate testing or when tests are negative, and they should be seen as important components of control programs, especially in the early stages of malaria elimination.…”