Malaria overdiagnosis: is patient pressure the problem?

Chandler, Clare I R; Mwangi, Rose; Mbakilwa, Hilda; Olomi, Raimos; Whitty, Christopher J M; Reyburn, Hugh

doi:10.1093/heapol/czm046

Cited by 63 publications

(57 citation statements)

References 32 publications

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“…This finding was also reflected in the perception assessment and consistent with the southwest Nigerian [17], Ghanaian [18] and North Eastern Tanzanian [19] studies.…”

Section: Discussionsupporting

confidence: 88%

Patients’ perception and satisfaction on quality of laboratory malaria diagnostic service in Amhara Regional State, North West Ethiopia

Bogale

Kassa

Ali

2015

Malar J

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BackgroundThe most effective strategies in the fight against malaria are to correctly diagnose and timely treat the illness. A diagnosis based on clinical symptoms alone is subjected to misuse of anti-malarial drugs, increased costs to the health services, patient dissatisfaction and also contributes to an increase in non-malaria morbidity and mortality. Among others, inappropriate perception and inadequate satisfaction of patients are significant challenges reported to affect the quality of laboratory malaria diagnostic services.MethodsA facility-based, cross-sectional study was conducted from November to December 2013 among 300 patients. Their level of satisfaction was measured using both pre-tested structured and open ended questionnaires. A 5-point Likert scales and their weighted average were used to categorize satisfaction level of the patients. Data were entered in Epi-Info version 3.5.3 and analysed using SPSS version 20. Chi-square test was used to see the association between the outcome variable and independent and the strength of the association was identified using odds ratio in the binary logistic regression. In addition the open ended questionnaire findings were coded and analysed thematically.ResultsOver half (52.6 %) of the patients were satisfied with the malaria diagnostic service with a 98.7 % response rate. The majority (89.3 %) of patients perceived they were well diagnosed in facing fever upon giving blood for laboratory malaria diagnosis within 30 min waiting time in most (62.5 %) of the patients. Ethnicity, residence, knowing malaria diagnosis after consulting clinician, and time period to receive malaria result were the independent predictors for patient satisfaction (p < 0.05). The open ended questionnaire responses also revealed providing precise laboratory result timely, availability of the right treatment, presence of health professionals performing the laboratory test upon request in the health facility were among the major enabling factors for patients’ satisfaction.ConclusionThe observed level of satisfaction in the current study though encouraging when compared with some previous studies conducted in eastern Ethiopia on general laboratory services, still it requires scale-up in the enhancement of malaria laboratory diagnostic service in the fight against malaria.

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“…This finding was also reflected in the perception assessment and consistent with the southwest Nigerian [17], Ghanaian [18] and North Eastern Tanzanian [19] studies.…”

Section: Discussionsupporting

confidence: 88%

Patients’ perception and satisfaction on quality of laboratory malaria diagnostic service in Amhara Regional State, North West Ethiopia

Bogale

Kassa

Ali

2015

Malar J

View full text Add to dashboard Cite

show abstract

“…Social relationships are often based on a perceived or real demand from patients for antimalarials (Chandler et al, 2008b;Onwujekwe et al, 2009) as well as habitual practice built on observation and expectations from colleagues within communities of practice (Chandler et al, 2008a;Chandler et al, 2010). Undertaking qualitative studies to understand local conceptualisations of malaria treatment and diagnosis is essential in order to design supporting interventions for the introduction of new technologies such as RDTs in different settings.…”

Section: Introductionmentioning

confidence: 99%

‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests

Chandler

Mangham

Abanda

et al. 2012

Social Science & Medicine

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“…[26,27] While these are sensitive for the diagnosis of severe malaria, they are also present in other illnesses. [2,28,29,30] Thus when paired with a highly sensitive method of malaria diagnosis, ultrasonographic measurement of spleen and liver size is promising as part of the diagnostic algorithm for malaria. [2] Over-diagnosis of severe malaria not only induces unnecessary economical burden for the patients and healthcare providers, but also leads to the failure in treating other life-threatening diseases.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound diagnosis of malaria: examination of the spleen, liver, and optic nerve sheath diameter

Zha¹,

Zhou²,

Hari³

et al. 2015

World Journal of Emergency Medicine

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BACKGROUND: Over 90% of all cases of malaria worldwide occur in Africa. Current methods of diagnosis are time and labor intensive, and could lead to delayed treatment. METHODS:In this study we investigated the effectiveness of measurements of spleen, liver, and optic nerve sheath diameter (ONSD) in identifying patients with malaria or severe malaria through the use of hand-held ultrasound devices. We recruited 40 adult patients with malaria and 16 adult control subjects at two hospitals in Mwanza, Tanzania. Ultrasonographic diagnosis was compared with rapid antigen diagnostic test and peripheral blood smear as the gold standards. An receiver operating characteristic curve test was performed to determine the most optimal diagnostic threshold for malaria and severe malaria, using each of the measurements for liver size, spleen size, and ONSD. The thresholds were determined to be >12 cm for spleen length and >15.1 cm for liver length, whereas ONSD was not signifi cant in this study. RESULTS:The sensitivities for malaria diagnosis were 66.7% and 58.3% for liver and spleen length respectively, suggesting that these measurements may not be suitable for identifying patients with severe malaria. However, the high specificity of 90.9% for spleen length and the acceptable specifi city of 75.0% for liver length suggest that these measurements can be used as a method to eliminate false-positive diagnoses (i.e. patients who do not have severe malaria but are classifi ed as having it by a test with a high sensitivity), giving a high positive predictive value. CONCLUSIONS:We report a high specifi city for spleen size and a moderate specifi city for liver size in the ultrasonographic diagnosis of severe malaria. Thus when paired with a highly sensitive method of malaria diagnosis, ultrasonographic measurement of spleen and liver size is promising as part of a diagnostic algorithm for malaria. It could be used to stratify risk in patients diagnosed with malaria and assist in their triage. If no sensitive tests are available, ultrasound might be useful to suggest malaria as a cause of a patient's constellation of clinical symptoms.

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Malaria overdiagnosis: is patient pressure the problem?

Cited by 63 publications

References 32 publications

Patients’ perception and satisfaction on quality of laboratory malaria diagnostic service in Amhara Regional State, North West Ethiopia

Patients’ perception and satisfaction on quality of laboratory malaria diagnostic service in Amhara Regional State, North West Ethiopia

‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests

Ultrasound diagnosis of malaria: examination of the spleen, liver, and optic nerve sheath diameter

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