Time delays in the diagnosis and treatment of malaria in non-endemic countries: A systematic review

Abstract

Patient delays accounted for a large proportion of the overall diagnostic delay; however the retrospective nature of the studies could have overestimated patient delay since previous healthcare contacts were not included. Additionally, the high frequency of studies reporting a clinically significant delay is a major concern.

Imported malaria in the UK, 2005 to 2016: Estimates from primary care electronic health records

“…The comparability of our findings to that from other UK data sources supports the use of this routinely collected data source for further research. Since the majority of previous malaria related research is retrospective [35], the routine recording in primary care datasets can allow prospective evaluation of the sequence of care prior to a diagnosis amongst the cases identified in this study. Given that prompt diagnosis and treatment of malaria remains a challenge in primary care [36], future research can use primary care data to identify missed opportunities for diagnosis and explore factors associated with it.…”

Plasma mEV levels in Ghanain malaria patients with low parasitaemia are higher than those of healthy controls, raising the potential for parasite markers in mEVs as diagnostic targets

“…The 434 patients, from the Western region of Ghana, aged between 6 months and 70 years were incorporated into the study after providing written consent in accordance with ethical committee guidelines from the University of Ghana, College of Health Sciences, for work on human subjects (see above). For all cases presenting with mild symptoms of infection (uncomplicated malaria), as we were unable to report the exact duration of fever or of clinical symptoms, we reported the "patient delay," PD [50][51][52]o r"delay in seeking healthcare," defined as the period (≥24 h) between onset of symptoms (temperature ≥38°C, vomiting, headaches, muscle pain or diarrhoea) until seeking medical healthcare. Patients were treated with antimalarials (a standard course of artemisinin based derivative combination therapy) and other support therapies.…”

“…In this study carried out over the course of one year in Ghana, we investigated parasitaemia and corresponding plasma mEV levels that occur when malaria infection is not reported early enough. Blood samples of patients were analysed, based on the period from the onset of symptoms related to malaria (temperature of ≥38°C, vomiting, headaches, muscle pain or diarrhoea) until seeking medical healthcare, the so-called Patient Delay (PD) [50][51][52]. We set out to quantify mEVs in patients infected with P. falciparum and to ascertain whether there was any possible influence of parasitaemia levels and/or PD as well as age or gender of patients.…”

Evaluation of the sick returned traveler

“…Delays in diagnosis after patients present to healthcare facilities appears to contribute to the delay in malaria treatment that is common in non-endemic countries, although delays in seeking healthcare by the patient appears to be the largest factor. 24 Surveys of malaria diagnostic capacity in U.S. hospitals has suggested recent improvement, although still only 12% of laboratories that responded met all Clinical and Laboratory Standards Institute (CLSI) guidelines for analysis and reporting of malaria testing. 25,26 Antigen-based rapid diagnostic tests (RDTs) can expedite malaria diagnosis, particularly in situations where expert readings of blood smears are not immediately available.…”