title: The benefits or otherwise of managing malaria cases with or without laboratory diagnosis: the experience in a district hospital in Ghana.
abstract: BACKGROUND
  This study was conducted at the Kintampo Municipal Hospital in Ghana to determine whether there was any benefit (or otherwise) in basing the management of cases of suspected malaria solely on laboratory confirmation (microscopy or by RDT) as compared with presumptive diagnosis.
  
  
  METHODS
  Children under five years who reported at the Out-Patient Department of the Hospital with axillary temperature ≥37.5°C or with a 48 hr history of fever were enrolled and had malaria microscopy and RDT performed. The attending clinician was blinded from laboratory results unless a request for these tests had been made earlier. Diagnosis of malaria was based on three main methods: presumptive or microscopy and/or RDT. Cost implication for adopting laboratory diagnosis or not was determined to inform malaria control programmes.
  
  
  RESULTS
  In total, 936 children were enrolled in the study. Proportions of malaria diagnosed presumptively, by RDT and microscopy were 73.6% (689/936), 66.0% (618/936) and 43.2% (404/936) respectively. Over 50% (170/318) of the children who were RDT negative and 60% (321/532) who were microscopy negative were treated for malaria when presumptive diagnoses were used. Comparing the methods of diagnoses, the cost of malaria treatment could have been reduced by 24% and 46% in the RDT and microscopy groups respectively; the reduction was greater in the dry season (43% vs. 50%) compared with the wet season (20% vs. 45%) for the RDT and microscopy confirmed cases respectively.
  
  
  CONCLUSIONS
  Over-diagnosis of malaria was prevalent in Kintampo during the period of the study. Though the use of RDT for diagnosis of malaria might have improved the quality of care for children, it appeared not to have a cost saving effect on the management of children with suspected malaria. Further research may be needed to confirm this.
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Ministry of Health, Kintampo, Ghana.
authors.forename: Kingsley
authors.initials: K
authors.lastname: Osei-Kwakye
authors.forename: Kwaku Poku
authors.initials: KP
authors.lastname: Asante
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Mahama
authors.forename: Stephen
authors.initials: S
authors.lastname: Apanga
authors.forename: Ruth
authors.initials: R
authors.lastname: Owusu
authors.forename: Evans
authors.initials: E
authors.lastname: Kwara
authors.forename: George
authors.initials: G
authors.lastname: Adjei
authors.forename: Livesy
authors.initials: L
authors.lastname: Abokyi
authors.forename: Enuameh
authors.initials: E
authors.lastname: Yeetey
authors.forename: David Kwame
authors.initials: DK
authors.lastname: Dosoo
authors.forename: Damien
authors.initials: D
authors.lastname: Punguyire
authors.forename: Seth
authors.initials: S
authors.lastname: Owusu-Agyei
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000191:economics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000191:economics / Q000379:methods; D003430:Cross-Sectional Studies; D005260:Female; D005869:Ghana; D017048:Health Care Costs; D006767:Hospitals, District; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D000962:Antimalarials