ehealth digital library

Digital library of
the Tanzania
health
community

Challenges in Diagnosing Paediatric Malaria in Dar es Salaam, Tanzania.

Strøm, G. E. A., Haanshuus, C. G., Fataki, M., Langeland, N. and Blomberg, B. (2013) Challenges in Diagnosing Paediatric Malaria in Dar es Salaam, Tanzania. Malaria journal, 12. p. 228. ISSN 1475-2875

[img]
Preview
PDF
Gro_EA_Strøm1.pdf - Published Version
Available under License Creative Commons Attribution Non-commercial.

Download (1MB)

Abstract

Malaria is a major cause of paediatric morbidity and mortality. As no clinical features clearly differentiate malaria from other febrile illnesses, and malaria diagnosis is challenged by often lacking laboratory equipment and expertise, overdiagnosis and overtreatment is common. Children admitted with fever at the general paediatric wards at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania from January to June 2009 were recruited consecutively and prospectively. Demographic and clinical features were registered. Routine thick blood smear microscopy at MNH was compared to results of subsequent thin blood smear microscopy, and rapid diagnostics tests (RDTs). Genus-specific PCR of Plasmodium mitochondrial DNA was performed on DNA extracted from whole blood and species-specific PCR was done on positive samples. Among 304 included children, 62.6% had received anti-malarials during the last four weeks prior to admission and 65.1% during the hospital stay. Routine thick blood smears, research blood smears, PCR and RDT detected malaria in 13.2%, 6.6%, 25.0% and 13.5%, respectively. Positive routine microscopy was confirmed in only 43% (17/40), 45% (18/40) and 53% (21/40), by research microscopy, RDTs and PCR, respectively. Eighteen percent (56/304) had positive PCR but negative research microscopy. Reported low parasitaemia on routine microscopy was associated with negative research blood slide and PCR. RDT-positive cases were associated with signs of severe malaria. Palmar pallor, low haemoglobin and low platelet count were significantly associated with positive PCR, research microscopy and RDT. The true morbidity attributable to malaria in the study population remains uncertain due to the discrepancies in results among the diagnostic methods. The current routine microscopy appears to result in overdiagnosis of malaria and, consequently, overuse of anti-malarials. Conversely, children with a false positive malaria diagnosis may die because they do not receive treatment for the true cause of their illness. RDTs appear to have the potential to improve routine diagnostics, but the clinical implication of the many RDT-negative, PCR-positive samples needs to be elucidated.

Item Type: Article
Keywords: Malaria, Diagnostics, Polymerase chain reaction, Blood microscopy, Rapid diagnostic test, Tanzania, Paediatrics, Fever
Subjects: Malaria > Diagnosis & treatment
Divisions: Muhimbili University of Health and Allied Sciences (MUHAS)
Depositing User: Mr Joseph Madata
Date Deposited: 28 Jan 2014 09:19
Last Modified: 28 Jan 2014 09:19
URI: http://ihi.eprints.org/id/eprint/2397

Actions (login required)

Edit Item Edit Item

Downloads

Downloads per month over past year

View more statistics