Diagnosis and treatment of malaria in peripheral health facilities in Uganda: findings from an area of low transmission in south-western Uganda

Ndyomugyenyi, Richard; Magnussen, Pascal; Clarke, Siân E.

doi:10.1186/1475-2875-6-39

Cited by 61 publications

(59 citation statements)

References 21 publications

(28 reference statements)

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“…Several studies have reported misdiagnosed [11]–[13] and over-treated [6], [14], [15] clinical malaria cases in different countries in Africa. Ndyomugyenyi and others [14] reported in their study on peripheral health facilities in Uganda, that only 24.8% of 1627 patients had clinical malaria according to the case definition, and >75% of patients were unnecessarily treated for malaria, with few slide negative cases receiving alternative treatment. Their findings on the proportion of patients who actually had clinical malaria were even lower than ours (37%).…”

Section: Discussionmentioning

confidence: 99%

Utility of Health Facility-based Malaria Data for Malaria Surveillance

et al. 2013

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BackgroundCurrently, intensive malaria control programs are being implemented in Africa to reduce the malaria burden. Clinical malaria data from hospitals are valuable for monitoring trends in malaria morbidity and for evaluating the impacts of these interventions. However, the reliability of hospital-based data for true malaria incidence is often questioned because of diagnosis accuracy issues and variation in access to healthcare facilities among sub-groups of the population. This study investigated how diagnosis and treatment practices of malaria cases in hospitals affect reliability of hospital malaria data.Methodology/Principal FindingsThe study was undertaken in health facilities in western Kenya. A total of 3,569 blood smears were analyzed after being collected from patients who were requested by clinicians to go to the hospital’s laboratory for malaria testing. We applied several quality control measures for clinical malaria diagnosis. We compared our slide reading results with those from the hospital technicians. Among the 3,390 patients whose diagnoses were analyzed, only 36% had clinical malaria defined as presence of any level of parasitaemia and fever. Sensitivity and specificity of clinicians’ diagnoses were 60.1% (95% CI: 61.1−67.5) and 75.0% (95% CI: 30.8−35.7), respectively. Among the 980 patients presumptively treated with an anti-malarial by the clinicians without laboratory diagnosis, only 47% had clinical malaria.Conclusions/SignificanceThese findings revealed substantial over-prescription of anti-malarials and misdiagnosis of clinical malaria. More than half of the febrile cases were not truly clinical malaria, but were wrongly diagnosed and treated as such. Deficiency in malaria diagnosis makes health facility data unreliable for monitoring trends in malaria morbidity and for evaluating impacts of malaria interventions. Improving malaria diagnosis should be a top priority in rural African health centers.

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Section: Discussionmentioning

confidence: 99%

Utility of Health Facility-based Malaria Data for Malaria Surveillance

et al. 2013

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“…Dengue diagnosis is likely confounded by other diseases such as malaria and lack of laboratory diagnostic capability [14,15]. For example in regions endemic for malaria, 70% of febrile illnesses are treated as presumptive malaria or designated as having fever of unknown origin, hence the potential for misdiagnosing dengue as malaria.…”

Section: Introductionmentioning

confidence: 99%

Dengue Outbreak in Mombasa City, Kenya, 2013–2014: Entomologic Investigations

et al. 2016

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Dengue outbreaks were first reported in East Africa in the late 1970s to early 1980s including the 1982 outbreak on the Kenyan coast. In 2011, dengue outbreaks occurred in Mandera in northern Kenya and subsequently in Mombasa city along the Kenyan coast in 2013–2014. Following laboratory confirmation of dengue fever cases, an entomologic investigation was conducted to establish the mosquito species, and densities, causing the outbreak. Affected parts of the city were identified with the help of public health officials. Adult Ae. aegypti mosquitoes were collected using various tools, processed and screened for dengue virus (DENV) by cell culture and RT-PCR. All containers in every accessible house and compound within affected suburbs were inspected for immatures. A total of 2,065 Ae. aegypti adults were collected and 192 houses and 1,676 containers inspected. An overall house index of 22%, container index, 31.0% (indoor = 19; outdoor = 43) and Breteau index, 270.1, were observed, suggesting that the risk of dengue transmission was high. Overall, jerry cans were the most productive containers (18%), followed by drums (17%), buckets (16%), tires (14%) and tanks (10%). However, each site had specific most-productive container-types such as tanks (17%) in Kizingo; Drums in Nyali (30%) and Changamwe (33%), plastic basins (35%) in Nyali-B and plastic buckets (81%) in Ganjoni. We recommend that for effective control of the dengue vector in Mombasa city, all container types would be targeted. Measures would include proper covering of water storage containers and eliminating discarded containers outdoors through a public participatory environmental clean-up exercise. Providing reliable piped water to all households would minimize the need for water storage and reduce aquatic habitats. Isolation of DENV from male Ae. aegypti mosquitoes is a first observation in Kenya and provides further evidence that transovarial transmission may have a role in DENV circulation and/or maintenance in the environment.

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“…In sub-Saharan Africa, where health resources are limited, fever has been used as a cornerstone for instituting presumptive treatment of malaria [4-6] and it is an important component of the guidelines for integrated management of childhood illnesses (IMCI) [7] and home management of malaria [8]. However, with a declining malaria burden in some areas in Africa, dependency on fever as a marker of malaria infection may be compromised by altered sensitivity and specificity due to low levels of malaria prevalence in the community [4,9].…”

Section: Introductionmentioning

confidence: 99%

Using community-owned resource persons to provide early diagnosis and treatment and estimate malaria burden at community level in north-eastern Tanzania

Rutta

Francis

Mmbando

et al. 2012

Malar J

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BackgroundAlthough early diagnosis and prompt treatment is an important strategy for control of malaria, using fever to initiate presumptive treatment with expensive artemisinin combination therapy is a major challenge; particularly in areas with declining burden of malaria. This study was conducted using community-owned resource persons (CORPs) to provide early diagnosis and treatment of malaria, and collect data for estimation of malaria burden in four villages of Korogwe district, north-eastern Tanzania.MethodsIn 2006, individuals with history of fever within 24 hours or fever (axillary temperature ≥37.5°C) at presentation were presumptively treated using sulphadoxine/pyrimethamine. Between 2007 and 2010, individuals aged five years and above, with positive rapid diagnostic tests (RDTs) were treated with artemether/lumefantrine (AL) while under-fives were treated irrespective of RDT results. Reduction in anti-malarial consumption was determined by comparing the number of cases that would have been presumptively treated and those that were actually treated based on RDTs results. Trends of malaria incidence and slide positivity rates were compared between lowlands and highlands.ResultsOf 15,729 cases attended, slide positivity rate was 20.4% and declined by >72.0% from 2008, reaching <10.0% from 2009 onwards; and the slide positivity rates were similar in lowlands and highlands from 2009 onwards. Cases with fever at presentation declined slightly, but remained at >40.0% in under-fives and >20.0% among individuals aged five years and above. With use of RDTs, cases treated with AL decreased from <58.0% in 2007 to <11.0% in 2010 and the numbers of adult courses saved were 3,284 and 1,591 in lowlands and highlands respectively. Malaria incidence declined consistently from 2008 onwards; and the highest incidence of malaria shifted from children aged <10 years to individuals aged 10–19 years from 2009.ConclusionsWith basic training, supervision and RDTs, CORPs successfully provided early diagnosis and treatment and reduced consumption of anti-malarials. Progressively declining malaria incidence and slide positivity rates suggest that all fever cases should be tested with RDTs before treatment. Data collected by CORPs was used to plan phase 1b MSP3 malaria vaccine trial and will be used for monitoring and evaluation of different health interventions. The current situation indicates that there is a remarkable changing pattern of malaria and these areas might be moving from control to pre-elimination levels.

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Diagnosis and treatment of malaria in peripheral health facilities in Uganda: findings from an area of low transmission in south-western Uganda

Cited by 61 publications

References 21 publications

Utility of Health Facility-based Malaria Data for Malaria Surveillance

Utility of Health Facility-based Malaria Data for Malaria Surveillance

Dengue Outbreak in Mombasa City, Kenya, 2013–2014: Entomologic Investigations

Using community-owned resource persons to provide early diagnosis and treatment and estimate malaria burden at community level in north-eastern Tanzania

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