Abstract
Background: World Health Organization and Ministry of Health (Uganda) recommend use of microscopy for parasitological confirmation of malaria. Microscopy involves either Giemsa or Fields staining techniques. Ministry of Health prefers and recommends use of Giemsa staining technique but most health facilities still use Fields staining technique. The objective of this study was to compare the cost-effectiveness of Giemsa and Fields staining techniques in order to inform malaria diagnosis policy and practice in Uganda. Methods: This was a cross sectional cost effectiveness analysis from the providers perspective covering the period between April 25, 2014 and June 15, 2014. The study involved 243 children below five years of age presenting at Acute Care Unit laboratory for malaria test before admission. Giemsa and Fields staining techniques were compared with Polymerase Chain Reaction as the gold standard. Decision tree analytic model in TreeAge was used for the cost effectiveness analysis. Results: Fields and Giemsa staining techniques cost US $ 0.030 and US $ 0.769 respectively. Correctly diagnosed cases were 227 and 230 for Fields and Giemsa staining techniques respectively. The proportion of correctly diagnosed cases was 93.4% for Fields and 94.7% for Giemsa. Incremental cost effectiveness ratio was 0.35 US $ per additional correctly diagnosed case. Conclusion: Fields staining technique was more cost effective than Giemsa staining technique; provided a higher number of correctly diagnosed cases at a lower cost than Giemsa staining technique. Fields staining technique is recommended as staining technique for malaria diagnosis at the Acute Care Unit of Mulago National Referral Hospital. This implies that even with introduction of more superior staining techniques for laboratory diagnosis of malaria, Field staining technique is still a cost effective technique to be used in resource limited settings with high malaria burden like Uganda and Africa at large.
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