Prevalence and factors associated with malaria misdiagnosis among children in Mulago Hospital

Abstract

Malaria remains a major cause of morbidity and mortality in Uganda especially among children under five years of age. Reliable diagnosis is essential to reduce this burden. World Health Organisation (WHO) guidelines recommend microscopy as the gold standard for malaria diagnosis for hospital setting. However in clinical practice malaria diagnosis is done using routine microscopy, which still suffers great limitations, and is significantly compromised especially at low parasite density infections. We set out to determine the burden of malaria misdiagnosis by routine microscopy in Mulago National Referral hospital (MNRH). Objectives: The aim of this study was to determine the prevalence and factors associated with malaria misdiagnosis among children 2 months to 12 years in Acute Care Unit, MNRH. The secondary objective was to determine the role of addition of malaria Rapid diagnostic test (RDT) to routine microscopy on the accuracy of malaria diagnosis in a hospital setting. Methods: This was a cross sectional study, targeting children aged 2 months to 12 years. The study was carried out in Acute Care Unit (ACU), MNRH. Children diagnosed with malaria and with anti-malarial drug prescription in their medical records at ACU were enrolled in the study. Relevant medical history was taken and physical examination done on each child. Blood samples were taken for RDT and expert microscopy. The burden of malaria misdiagnosis was determined by comparing the routine microscopy results with the expert. Logistic regression was done, and also key informant interviews carried out to explain factors associated with malaria misdiagnosis by routine microscopy. The role of addition of RDT to routine microscopy was determined by comparing the prevalence of misdiagnosis by routine microscopy alone verses a combination of routine microscopy and RDT.