Abstract
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.
Keywords: Malaria, healthcare providers’, diagnosis, participants, chemotherapy
Résumé
Le diagnostique exact et le traitement jouent un rôle capital dans le programme de control du paludisme en Afrique sub-saharienne. Cependant, dans la plupart des cas, le diagnostique n’est pas confirme soit a cause du manque de facilités ou le manque d’intérêt de la part des responsables de soins de sante résultant d’un excès de diagnostique. Pour déterminer le taux de cas de paludisme cliniquement diagnostiques qui pourrait être confirmés au microscope et évaluer le conformisme des responsables des soins de santé avec le mode de traitement national pour le paludisme. Les participants étaient des patients admis pour les abces palustre âpres que le médecin ait fait des diagnostiques de paludisme. Au total 630 patients étaient admis avec des signes et symptomes du paludisme, 224 ou 35.6% étaient testés positif aux parasites de paludisme. Les patients testés positifs étaient jeunes avec une moyenne d’âge de 10.6 + 13.0 ans contre 17.26+ 18.5 ans [P<0.005] pour les individus testés négatifs. Il y’avait seulement quelques cas de nonconformisme avec le code national de traitement du paludisme. En conclusion, il parait avoir un excès de diagnostique de paludisme considérant environ le tiers des cas de paludisme était confirmé au microscope. Il y’a un besoin en études épidémiologiques et les revues de politique possibles
Correspondence: Dr. F.A.Fehintola, Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: fentolamine@yahoo.com OR fehintolaf@comui.edu.ng
References
WHO. 2008. World Health Statistics 2008: Mortality and burden of disease. Geneva: WHO. 36-64
Bryce J, Bosch-Pinto C and Black RE. WHO estimates of the causes of death in children. Lancet. 2005; 365(9465): 1147-1152
Black RE and Morris SS. Where and why are 10 million children dying every year? Lancet 2003; 361(9376): 2226- 2234
Ndyomugyenyi R, Magnussen P and Clarke S. Diagnosis and treatment of malaria in peripheral health facilities in Uganda: findings from an area of low transmission in south western Uganda. Malaria Journal. 2007; 6: 39 WWW.malariajournal.com/content/6/1/39
Koram KA and Molyneux ME. When is “malaria” malaria? The different burdens of malaria infection, malaria disease and malaria-like illnesses. Am J Trop Med Hyg. 2007; 77 (suppl. 6): 1-5
Makler MT, Palmer CJ and Ager AL. A review of practical techniques for the diagnosis of malaria. Annals of Tropical Medicine & Parasitology. 1998; 92 (4): 419-433
World Health Organization. Antimalarial Drug Combination Therapy. Report of a WHO Technical Consultation. WHO/CDS/RBM/2001.35. Geneva: WHO.
Nigeria Federal Ministry of Health National Antimalarial Treatment Policy, Abuja 2004
Annonymous. Epi-info version 6. A word processing data base and statistics program for public health on IBM-convertible microcomputers. Atlanta, Georgia: Centres for Disease Control and Prevention, Geneva: World Health Organisation 1994.
Font F, Gonzalez MA, Nathan R, Kimario J, Liwilla F, Ascaso C, Tanner M, Menendez C and Alonso PL. Diagnostic accuracy and case management of clinical malaria in the primary health services of a rural area in south-eastern Tanzania. Tropical Medicine & International Health. 2001; 6 (6): 423-428
D’Acremont V, Lengeler C, Mshinda H, Mtasiwa D, Tanner M and Genton B. Time to move from presumptive malaria treatment to laboratory-confirmed Diagnosis and treatment in African children with fever. PLoS Medicine January 2009 Volume 6 Issue 1. www.plosmedicine.org
WHO. Integrated management of the sick child Bulletin of World Health Organization 1995; 73: 735-740
WHO. 2006. WHO Guidelines for treatment of malaria. WHO/HTM/MAL/2006.1108
World Health Organization. Severe falciparum malaria. Trans. R. Soc. Trop. Med. Hyg. 2000; 94 (Suppl. 1): 1-90.
Kallander K, Nsungwa-Sabitii J and Peterson S. Symptom overlap for malaria and pneumonia – policy implications for home management strategies. Acta Tropica. 2004; 90: 211-214
Fehintola FA, Adedeji AA, and Sowunmi A. Comparative efficacy of chloroquine and cotrimoxazole in the treatment of acute uncomplicated falciparum malaria in Nigerian children. Cent Afr J Med. 2002; 48(9): 101-105.
Fehintola FA, Adedeji AA, Tambo E, Fateye BA, Happi TC and Sowunmi A. Cotrimoxazole in the treatment of falciparum malaria in Nigerian children: A controlled clinical trial. Clin Drug Invest. 2004; 24(3): 149-155
Chandler CIR, Mwangi R, Mbaligwa H, Olomi R, Whitty CJM and Reyburn H. Malaria over-diagnosis: is pressure the problem? Health Policy and Planning. 2008; 23: 170-178
Rougemont M, Van Saanen M, Sahli R, Hinrikson HR, Bille J and Jaton K. Detection of four Plasmodium species in blood from humans by 18S rRNA gene subunit based and species-specific Real-Time PCR assays. Journal of Clinical Microbiology. 2004; 42 (12): 5636-5643
Akinyede AA, Mabadeje AFB and Aliu MO. A comparative study of patterns of prescription of antibiotics in two health centres in Lagos. Journal of the Nigerian Association of Infection Control. 2000; 3:20-23.
Fehintola FA, Ganiyu AA, Akinmusure O, Oduntan HA and Adeyinka JO. Cotrimoxazole prescription at the outpatient service of a secondary health facility in Ibadan, Nigeria. J Med Sci. 2006; 6( 3): 416-419
Wernsdorfer WH. The development and spread of resistant malaria. Parasitology Today. 1991; 7: 297-303.
Iwalokun BA, Gbenle GO, Smith SI, Ogunledun A, Akinsinde KA and Omonigbehin EA. Epidemiology of Shigellosis in Lagos, Nigeria: Trends in antimicrobial resistance. J Health Popul. Nutr. 2001; 19(3): 183-190
Okesola AO and Ige MO. Trends in bacterial pathogens of lower respiratory tract infections. The Indian Journal of Chest Diseases and Allied Sciences. 2008; 50:269-271.
D’Alessandro U and Buttiens H. History and importance of antimalarial drug resistance. Tropical Medicine and International Health. 2001; 6(11): 845-848
Nuwaha F. The challenge of chloroquine-resistant malaria in sub Saharan Africa. Health Policy and Planning 2001; 16(1): 1-1