Diagnostic accuracy and case management of clinical malaria in the primary health services of a rural area in south‐eastern Tanzania

Abstract

SummaryMalaria control continues to rely on the diagnosis and prompt treatment of both suspected and con®rmed cases through the health care structures. In south-eastern Tanzania malaria is one of the leading causes of morbidity and mortality. The absence of microscopic examination in most of the health facilities implies that health workers must rely on clinical suspicion to identify the need of treatment for malaria. Of 1558 randomly selected paediatric consultations at peripheral health facilities throughout Kilombero District, 41.1% were diagnosed by the attending health worker as clinical malaria cases and 42.5% prescribed an antimalarial. According to our malaria case de®nition of fever or history of fever with asexual falciparum parasitaemia of any density, 25.5% of all children attending the health services had malaria. This yielded a sensitivity of 70.4% (IC95% 65.9±74.8%) and a speci®city of 68.9% (IC95% 66.2±71.5%). Accordingly, 30.4% of con®rmed cases left with no antimalarial treatment. Among malaria-diagnosed patients, 10% were underdosed and 10.5% were overdosed. In this area, as in many African rural areas, the low diagnostic accuracy may imply that the burden of malaria cases may be overestimated. Greater emphasis on the functioning and quality of basic health services in rural endemic areas is required if improved case management of malaria is to help roll back this scourge.

Analysis of the genetic variants of glucose-6-phosphate dehydrogenase in inhabitants of the 4th Nile cataract region in Sudan

“…It has been reported that there was a reduction in the intensity of P. falciparum transmission over the previous ten years. The incidence of fever in Sudan is low; 1.8% is associated with P. falciparum [13]. The results of this study are in concordance with previous reports.…”

Knowledge and Perception of Malaria Rapid Diagnostic Test among Medical Doctors in a South Eastern Nigeria Tertiary Hospital

“…The use of presumptive diagnosis in the management of malaria commonly leads to diagnostic inaccuracies and over-diagnosis of malaria [28] [29]. This could endanger patients that have more deadly conditions such as Lassa fever or Yellow fever, by being erroneously treated for malaria while delaying the initiation of correct treatment for some of these potentially fatal diseases; whose prognoses is positively affected by early initiation of treatment.…”

Quality Assurance of Rapid Diagnostic Tests for Malaria in Routine Patient Care in Rural Tanzania

“…Clinical diagnosis alone is not specific and results in inappropriate use of antimalarial drugs. [1][2][3][4][5] Increasing drug resistance to inexpensive antimalarial drugs and the higher cost of alternative medications has led to an increased focus on malaria diagnosis. Rapid diagnostic tests (RDTs) were developed to improve the quality of malaria diagnosis in resource-limited settings.…”