Over-Diagnosis and Co-Morbidity of Severe Malaria in African Children: A Guide for Clinicians

Abstract

Severe malaria is clinically similar to other severe febrile illnesses. However, in endemic areas, parasitological confirmation of parasitemia is often unavailable or unreliable. False-positive malaria microscopy is common. The most important consequence of treating only for malaria when no parasitemia exists is failure to address other life-threatening conditions. Invasive bacterial infections are detected in up to one third of children with clinical features of severe malaria but a slide with results negative for malaria. Even among genuinely parasitized children, severe illness is not always due to malaria in endemic areas. We believe that routine use of parenteral antibiotics among children with a slide that indicates malaria and life-threatening disease is warranted because invasive bacterial infections are likely to be under-ascertained and are associated with increased mortality. Published data on co-morbidity with HIV infection and malnutrition are reviewed. A structured approach to assessment and care is essential, and is largely independent of underlying etiology.

Assessing Perceived Challenges to Laboratory Testing at a Malawian Referral Hospital

“…Finally, we only interviewed laboratory and medical staff at a single referral hospital in Malawi, but respondents identified challenges that have been identified in other lowresource laboratory settings. 1,[3][4][5][6]12 The results of this work provide evidence and context for challenges in the laboratory diagnostic process, motivating the development of interventions to improve the laboratory workflow and stature within the hospital. The choice to capture the pre-and post-analytical phases by including providers from the medical ward and laboratory staff, recognizes that challenges at any point in the process, regardless of location, undermine the ability of laboratory testing to improve health-care delivery and health outcomes.…”

“…Rather, the literature on laboratory challenges in low-resource settings focuses on disease-specific laboratory processes and interventions, such as microscopy for malaria, often addressing generalizable testing issues only in the context of a specific disease. [10][11][12][13] Understanding workflow barriers, perceptions of challenges, and the interactions between the laboratory and providers in low-resource settings is an important step to improving the use of laboratory testing across all conditions and diseases. This study aims to gain a more granular understanding of the specific challenges encountered in laboratory testing in a low-resource setting hospital laboratory, specifically the laboratory at Kamuzu Central Hospital (KCH), Malawi, as perceived by healthcare providers engaged in the diagnostic process.…”

Evaluating the impact of two training interventions to improve diagnosis and case-management of malaria and pneumonia in Uganda

“…Recent evidence shows that diseasespecific training in areas of high malaria burden may lead to sub-optimal health outcomes [4]. It is not uncommon for health practitioners to overtreat for malaria [12,13] and to underdiagnose and undertreat pneumonia [4,10,12]. In [12], for example, higher case-fatality ratios were observed in cases testing negative for malaria, as their pneumonia status was never assessed.…”

“…In individuals aged >5 years, malaria and pneumonia are not as pronounced but they still cause a considerable number of disease cases and deaths [6,7]. Malaria and pneumonia have overlapping symptoms when severe [2,[8][9][10][11] which makes diagnosis difficult.…”

Induction of Amodiaquine Metabolism by Rifampicin Following Concurrent Administration in Healthy Volunteers

“…3 Incidentally, in regions with high incidence of malaria infections, such as sub-Saharan Africa, malaria may coexist with other infections. 4 Tuberculosis (TB), an infection caused by Mycobacterium tuberculosis, is one of the top 10 leading tropical diseases that require long-term therapies. TB and malaria are the most prevalent bacterial and parasitic infections that coexist frequently in humans.…”