A clinical audit of the diagnosis of malaria in a rural Ugandan hospital

Abstract

Background: Malaria remains a serious public health issue in Uganda. World Health Organization recommendations have been implemented which aim to reduce the diagnosis of malaria without proper testing: all suspected patients should have a rapid diagnostic test before receiving treatment and certain, more severe cases should undergo blood-smear microscopy. The audit reported here assessed whether Kisiizi Hospital in Uganda's Rukungiri District meets this standard. Methods: Data were collected over 10 days in May 2014 from a 250-bed private hospital in rural southwestern Uganda. All patients commencing antimalarial treatment were included; new cases were found on daily ward visits and their notes were examined to assess whether diagnostic testing was conducted appropriately. Pharmacy and laboratory records were crosschecked to improve coverage. Proportions of correctly managed patients were then calculated and compared by ward, age group, and sex, and assessed for statistical significance. Results: Fifty-nine patients were included. Of these, 35 were male and the median age was 18 (interquartile range 4.5-31.0). Seven departments were included in the audit; Outpatients contributed the most patients with 25, while Psychiatry the fewest with one. In total, nine patients were not managed in accordance with guidelines. Three departments correctly tested 100.0% of patients, with the remainder ranging from 50.0% to 87.5%. Proportionally more adults were incorrectly managed than children under 18 years, however this was not statistically significant. Men were significantly (P=0.0242) more likely to be correctly managed than women. Conclusion: Kisiizi Hospital is performing relatively well in correctly diagnosing patients prior to treatment, compared to hospitals in similar settings. It must strive, however, for improvement. Appropriate staff education may help eliminate the difference between sexes and standardize quality between departments. Improvements in hospital record keeping would facilitate future audits in this and other areas. Re-audit following the implementation of any changes would be desirable.