Health systems
Working without a blindfold: the critical role of diagnostics in malaria control
Diagnosis: an integral component of malaria control
Authors:
M. D. Perkins; D. R. Bell
Publisher:
Malaria Journal, BioMed Central, 2008
Increases in the cases of malaria continue to pose a challenge for public health specialists. Despite advances in laboratory methods, pharmaceutical interventions and preventative measures, combating the increases in the cases of malaria still largely depends on the diagnosis and management of the disease.
This paper highlights how efforts to control malaria are influenced by the use of inappropriate methods for the diagnosis and treatment of malaria. The authors argue that while there have been changes in the management of malaria, these gains will be lost if suitable diagnostic methods are not utilised.
Traditionally, malaria was diagnosed through presumptive methods - that is the presence of a fever. While the authors recognise that this has resulted in positive health outcomes for some, the absence of laboratory methods for the diagnosis of malaria has resulted in the over-diagnosis of the disease. Furthermore, improper diagnosis of malaria can result in: wasted resources due to the prescription of anti-malarial drugs for patients who do not need them, drug resistance due to the improper use of the medications, and changes in public opinion about the disease and persons who are found to be positive.
The authors present the case for the use of rapid diagnostic tests in places where microscopy is unavailable as they recognise that the latter form of diagnosis is not only costly but difficult to utilise in remote settings. They also discuss methods to ensure the quality of the various diagnostic methods. The paper concludes by reiterating the need to utilise laboratory based methods of diagnosis rather than reliance on syndromic management, namely classifying all 'malaria-like' fevers as malaria, due to the increased likelihood for mis-diagnosis.
