Abstract
BackgroundEarly recognition of symptoms and signs perceived as malaria are important for effective case management, as few laboratories are available at peripheral health facilities. The validity and reliability of clinical signs and symptoms used by health workers to diagnose malaria were assessed in an area of low transmission in south-western Uganda.MethodsThe study had two components: 1) passive case detection where all patients attending the out patient clininc with a febrile illness were included and 2) a longitudinal active malaria case detection survey was conducted in selected villages. A malaria case was defined as any slide-confirmed parasitaemia in a person with an axillary temperature ≥ 37.5°C or a history of fever within the last 24 hrs and no signs suggestive of other diseases.ResultsCases of malaria were significantly more likely to report joint pains, headache, vomiting and abdominal pains. However, due to the low prevalence of malaria, the predictive values of these individual signs alone, or in combination, were poor. Only 24.8% of 1627 patients had malaria according to case definition and > 75% of patients were unnecessarily treated for malaria and few slide negative cases received alternative treatment.ConclusionIn low-transmission areas, more attention needs to be paid to differential diagnosis of febrile illnesses In view of suggested changes in anti-malarial drug policy, introducing costly artemisinin combination therapy accurate, rapid diagnostic tools are necessary to target treatment to people in need.
Highlights
Recognition of symptoms and signs perceived as malaria are important for effective case management, as few laboratories are available at peripheral health facilities
Effective case management (ECM) depends on early recognition of symptoms and signs, which are interpreted as a malaria episode and the clinical skills of a peripheral health care worker as there are often no resources for laboratory diagnosis in most malarious endemic areas [2,3]
391 (24.8%) were classified as malaria cases according to the case definition: with 29.4%, 23.6% and 24.8% in the age groups < 5, 5–15 and ≥ 16 years respectively
Summary
Recognition of symptoms and signs perceived as malaria are important for effective case management, as few laboratories are available at peripheral health facilities. The validity and reliability of clinical signs and symptoms used by health workers to diagnose malaria were assessed in an area of low transmission in south-western Uganda. ECM depends on early recognition of symptoms and signs, which are interpreted as a malaria episode and the clinical skills of a peripheral health care worker as there are often no resources for laboratory diagnosis in most malarious endemic areas [2,3]. Studies conducted in areas of low endemicity in Asia found that none of the reported symptoms or signs was a good predictor of malaria [5,6], how symptoms are perceived is culturally determined and, the validity of potential diagnostic symptoms has to be tested in different socio-cultural and epidemiological settings [6].
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