Risk factors for the accuracy of the initial diagnosis of malaria cases in China: a decision-tree modelling approach

Gang Li,Xiaoyu Chen,Shangfeng Tang,Donglan Zhang,Zhuo Chen,Da Feng,Xinyan Cai,Zhanchun Feng

doi:10.1186/s12936-021-04006-4

Abstract

BackgroundEarly accurate diagnosis and risk assessment for malaria are crucial for improving patients’ terminal prognosis and preventing them from progressing to a severe or critical stage. This study aims to describe the accuracy of the initial diagnosis of malaria cases with different characteristics and the factors that affect the accuracy in the context of the agenda for a world free of malaria.MethodsA retrospective study was conducted on 494 patients admitted to hospitals with a diagnosis of malaria from January 2014 through December 2016. Descriptive statistics were calculated, and decision tree analysis was performed to predict the probability of patients who may be misdiagnosed.ResultsOf the 494 patients included in this study, the proportions of patients seeking care in county-level, prefecture-level and provincial-level hospitals were 27.5% (n = 136), 26.3% (n = 130) and 8.3% (n = 41), respectively; the proportions of patients seeking care in clinic, township health centre and Centres for Disease Control and Prevention were 25.9% (n = 128), 4.1% (n = 20), and 7.9% (n = 39), respectively. Nearly 60% of malaria patients were misdiagnosed on their first visit, and 18.8% had complications. The median time from onset to the first visit was 2 days (IQR: 0-3 days), and the median time from the first visit to diagnosis was 3 days (IQR: 0–4 days). The decision tree classification of malaria patients being misdiagnosed consisted of six categorical variables: healthcare facilities for the initial diagnosis, time interval between onset and initial diagnosis, region, residence type, insurance status, and age.ConclusionsInsufficient diagnostic capacity of healthcare facilities with lower administrative levels for the first visit was the most important risk factor in misdiagnosing patients. To reduce diagnostic errors, clinicians, government decision-makers and communities should consider strengthening the primary care facilities, the time interval between onset and initial diagnosis, residence type, and health insurance status.

Highlights

Accurate diagnosis and risk assessment for malaria are crucial for improving patients’ terminal prognosis and preventing them from progressing to a severe or critical stage
After 70 years, there has been no report of autochthonous malaria cases for nearly four consecutive years, since 2017 [5, 6], meeting the goal of malaria elimination set by the World Health Organization [7, 8]
Around 80% were married, 62% lived in rural areas, 35% were employed in agriculture, and 70% had health insurance

Summary

Introduction

Accurate diagnosis and risk assessment for malaria are crucial for improving patients’ terminal prognosis and preventing them from progressing to a severe or critical stage. After 70 years, there has been no report of autochthonous malaria cases for nearly four consecutive years, since 2017 [5, 6], meeting the goal of malaria elimination set by the World Health Organization [7, 8]. With the sharp increase in international travel among Chinese people, the risk of imported malaria cases from malaria-endemic areas threatens the maintenance of the malaria elimination goal of China [9]. Plasmodium falciparum is the most common species, with potentially fatal outcomes [10]. The fatality of malaria cases in China is rising, with more than four-fifths of deaths associated with severe complications, such as severe brain/liver/kidney lesions, shock, and haemolysis [11, 12]

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