title: Clinical diagnosis of malaria and the risk of chloroquine self-medication in rural health centres in Burkina Faso.
abstract: OBJECTIVE
  To assess the quality of healthcare workers' performance with regard to malaria diagnosis and treatment and to assess patients' self-medication with chloroquine (CQ) before and after presentation at a health centre.
  
  
  METHODS
  In the rainy season 2004, in five rural dispensaries in Burkina Faso, we observed 1101 general outpatient consultations and re-examined all these patients. CQ whole blood concentrations of confirmed malaria cases were measured before and after treatment.
  
  
  RESULTS
  The clinical diagnosis based on fever and/or a history of fever had a sensitivity of 75% and a specificity of 41% when compared to confirmed malaria (defined as an axillary temperature of >/=37.5 degrees C and/or a history of fever and parasites of any density in the blood smear). Few febrile children under 5 years of age were assessed for other diseases than malaria such as pneumonia. No antimalarial was prescribed for 1.3% of patients with the clinical diagnosis malaria and for 24% of confirmed cases, while 2% received an antimalarial drug prescription without the corresponding clinical diagnosis. CQ was overdosed in 22% of the prescriptions. Before and 2 weeks after consultation, 25% and 46% respectively of the patients with confirmed malaria had potentially toxic CQ concentrations.
  
  
  CONCLUSIONS
  As long as artemisinin-based combination therapy remains unavailable or unaffordable for most people in rural areas of Burkina Faso, self-medication with and prescription of CQ are likely to continue despite increasing resistance. Apart from considering more pragmatic first-line regimens for malaria treatment such as the combination of sulfadoxine-pyrimethamine with amodiaquine, more and better training on careful clinical management of febrile children including an appropriate consideration of other illnesses than malaria should be made available in the frame of the IMCI initiative in sub-Saharan Africa.
authors.affiliation: Department of Tropical Hygiene and Public Health, University of Heidelberg, Heidelberg, Germany. karolinbec@hotmail.com
authors.forename: K
authors.initials: K
authors.lastname: Pfeiffer
authors.forename: F
authors.initials: F
authors.lastname: Some
authors.forename: O
authors.initials: O
authors.lastname: Müller
authors.forename: A
authors.initials: A
authors.lastname: Sie
authors.forename: B
authors.initials: B
authors.lastname: Kouyaté
authors.forename: W E
authors.initials: WE
authors.lastname: Haefeli
authors.forename: A
authors.initials: A
authors.lastname: Zoungrana
authors.forename: L L
authors.initials: LL
authors.lastname: Gustafsson
authors.forename: G
authors.initials: G
authors.lastname: Tomson
authors.forename: R
authors.initials: R
authors.lastname: Sauerborn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000962:Antimalarials / Q000008:administration & dosage*; D002050:Burkina Faso; D002648:Child; D002675:Child, Preschool; D002738:Chloroquine / Q000008:administration & dosage*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D018512:Parasitemia / Q000175:diagnosis / Q000188:drug therapy; D012423:Rural Health; D019035:Rural Health Services; D012651:Self Medication / Q000009:adverse effects; D012680:Sensitivity and Specificity
chemical_list: D000962:Antimalarials; D002738:Chloroquine