Malaria: passive case detection and healthcare providers' choices of chemotherapy.
Prompt diagnosis and treatment play a central role in the malaria control programme in sub Saharan Africa. However, in most cases the diagnoses are never confirmed either for lack of facility or disinterest of healthcare providers resulting in over-diagnosis. To determine the proportion of clinically diagnosed malaria cases who could be confirmed with microscopy and evaluate compliance of healthcare providers with the National treatment guidelines for malaria. Participants were patients referred for malaria microscopy after the attending physicians had made clinical diagnosis of malaria. Thick blood smears were made under strict asepsis, stained and thereafter examined under oil immersion objective lens. Of the 630 patients who were referred with clinical impression of malaria, only 224 or 35.6% were positive for malaria parasite. The slide positive patients were younger with a mean age of 10.6 +/- 13.0 years versus 17.2 +/- 18.5 years [P < 0.005] for the slide negative individuals. There were only few instances of non-compliance with the National treatment guidelines for malaria. In conclusion, there appears to be over-diagnosis of malaria considering that only about a third of the clinical malaria cases were confirmed by microscopy. There is need for large epidemiological studies and possible policy review.
Fehintola
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Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria. fentolamine@yahoo.com
Balogun
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D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000962:Antimalarials / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002755:Choice Behavior; D005260:Female; D019983:Guideline Adherence; D006282:Health Personnel; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D009549:Nigeria; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation / Q000706:statistics & numerical data; D055815:Young Adult
D000962:Antimalarials