Diagnosis of Children's Fever Attacks in Health Facilities in the City of Cabinda (Angola)

Abstract

According to WHO recommendations, antimalarial drugs should be used only after a biological confirmation of a malaria attack. In order to better understand the diagnosis decision-making and the use of the malaria tests (immunochromatographic test RDT and direct microscope observation), a survey was carried out in two health facilities in the city of Cabinda, Angola in 2014. Diagnosis and drug prescriptions by the health staff were observed in 787 febrile children. It clearly appeared that there was a lack of trust of the health professionals in the test results, especially in the RDT. They tended to take into account test results irregularly, giving a diagnosis of malaria for half the febrile children despite only 16% of positive RDT. Acute febrile illness and malaria attacks seemed thus frequently confused. Alternative causes for fever were rarely sought out. Antimalarial drugs were hence overprescribed. Better training for staff and of their supervision by experimented practitioners are one of the means envisaged for triggering real change in the providers' practice.