Malaria Misdiagnosis in Uganda – Implications for Policy Change


Show simple item record Nankabirwa, Joan en_US Zurovac, Dejan en_US Njogu, Julius N en_US Rwakimari, John B en_US Counihan, Helen en_US Snow, Robert W en_US Tibenderana, James K en_US 2012-01-11T22:26:02Z 2012-01-11T22:26:02Z 2009 en_US 2009-4-16 en_US
dc.identifier.citation Nankabirwa, Joan, Dejan Zurovac, Julius N Njogu, John B Rwakimari, Helen Counihan, Robert W Snow, James K Tibenderana. "Malaria misdiagnosis in Uganda – implications for policy change" Malaria Journal 8:66. (2009) en_US
dc.identifier.issn 1475-2875 en_US
dc.description.abstract BACKGROUND In Uganda, like in many other countries traditionally viewed as harbouring very high malaria transmission, the norm has been to recommend that febrile episodes are diagnosed as malaria. In this study, the policy implications of such recommendations are revisited. METHODS A cross-sectional survey was undertaken at outpatient departments of all health facilities in four Ugandan districts. The routine diagnostic practices were assessed for all patients during exit interviews and a research slide was obtained for later reading. Primary outcome measures were the accuracy of national recommendations and routine malaria diagnosis in comparison with the study definition of malaria (any parasitaemia on expert slide examination in patient with fever) stratified by age and intensity of malaria transmission. Secondary outcome measures were the use, interpretation and accuracy of routine malaria microscopy. RESULTS 1,763 consultations undertaken by 233 health workers at 188 facilities were evaluated. The prevalence of malaria was 24.2% and ranged between 13.9% in patients ≥5 years in medium-to-high transmission areas to 50.5% for children <5 years in very high transmission areas. Overall, the sensitivity and negative predictive value (NPV) of routine malaria diagnosis were high (89.7% and 91.6% respectively) while the specificity and positive predictive value (PPV) were low (35.6% and 30.8% respectively). However, malaria was under-diagnosed in 39.9% of children less than five years of age in the very high transmission area. At 48 facilities with functional microscopy, the use of malaria slide examination was low (34.5%) without significant differences between age groups, or between patients for whom microscopy is recommended or not. 96.2% of patients with a routine positive slide result were treated for malaria but also 47.6% with a negative result. CONCLUSION Current recommendations and associated clinical practices result in massive laria over-diagnosis across all age groups and transmission areas in Uganda. Yet, under-diagnosis is also common in children <5 years. The potential benefits of malaria microscopy are not realized. To address malaria misdiagnosis, Uganda's policy shift from presumptive to parasitological diagnosis should encompass introduction of malaria rapid diagnostic tests and substantial strengthening of malaria microscopy. en_US
dc.description.sponsorship COMDIS Research Programme Consortium; Wellcome Trust Principal Research Fellowship (#079080) en_US
dc.language.iso en en_US
dc.publisher BioMed Central en_US
dc.rights Copyright 2009 Nankabirwa et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. en_US
dc.rights.uri en_US
dc.title Malaria Misdiagnosis in Uganda – Implications for Policy Change en_US
dc.type article en_US
dc.identifier.doi 10.1186/1475-2875-8-66 en_US
dc.identifier.pubmedid 19371426 en_US
dc.identifier.pmcid 2671516 en_US

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