Health systems
Malaria misdiagnosis in Uganda – implications for policy change
The effectiveness of methods for diagnosing malaria
Authors:
J. Nankabirwa; D. Zurovac; J. N. Njogu
Publisher:
Malaria Journal, BioMed Central, 2009
This article examines the effectiveness of the current methods for the diagnosis of malaria in Uganda. Diagnosis has mainly been through presumptive management – that is diagnosis on the basis of episodes of fever. However, the authors of this paper argue that while these recommendations are valid, this form of diagnosis has significantly contributed to the over-diagnosis of malaria in all age groups in mid to high transmission areas. While the diagnosis in children under the age of five years old using this method has led to under-diagnosis.
The study investigators conducted interviews with patients at 188 facilities and took laboratory samples in order to assess the accuracy of the existing diagnosis. It was found that the overall prevalence of malaria was around 24.2 percent, with a rate of 13.9 percent in adults and 50.5 percent for children under the age of five years old. Furthermore, the use of microscopy was lower than expected in facilities where this diagnostic method was available. In terms of treatment for malaria, 96.2 percent of patients with a positive diagnosis received treatment as well as 47.6 percent of patients with a negative result.
In order to address issues pertaining to the misdiagnosis of malaria, the current reliance on the existence of fever should be re-examined. The study authors therefore argue for changes in existing public health policy to include the use of laboratory methods such as microscopy and the introduction of malaria rapid diagnostic tests in order to reduce the incidence of malaria misdiagnosis in Uganda.
