Reducing microscopy-based malaria misdiagnosis in a low-resource area of Tanzania

  • Lisa K. Allen University of Calgary
  • Jennifer M Hatfield University of Calgary
  • Mange J. Manyama Catholic University of Health and Allied Sciences, Mwanza
Keywords: malaria, microscopy, misdiagnosis, Tanzania

Abstract

Misdiagnosis of malaria is a major problem in Africa leading not only to incorrect individual level treatment, but potentially the acceleration of the spread of drug resistance in low-transmission areas. In this paper we report on the outcomes of a simple intervention that utilized a social entrepreneurship approach (SEA) to reduce misdiagnosis associated with hospital-based microscopy of malaria in a low-transmission area of rural Tanzania. A pre-post assessment was conducted on patients presenting to the hospital outpatient department with malaria and non-malaria like symptoms in January 2009 (pre-intervention) and June 2009 (post-intervention). All participants were asked a health seeking behavior questionnaire and blood samples were taken for local and quality control microscopy. Multivariate logistic regression was conducted to determine magnitude of misdiagnosis with local microscopy pre- versus- post intervention. Local microscopy pre-intervention specificity was 29.5% (95% CI = 21.6% – 38.4%) whereas the post intervention specificity was 68.6% (95% CI = 60.2% - 76.2%). Both pre and post intervention sensitivity were difficult to determine due to an unexpected low number of true positive cases. The proportion of participants misdiagnosed pre-intervention was 70.2% (95%CI = 61.3%-78.0%) as compared to 30.6% (95%CI = 23.2%–38.8%) post-intervention. This resulted in a 39.6% reduction in misdiagnosis of malaria at the local hospital. The magnitude of misdiagnosis for the pre-intervention participants was 5.3 (95%CI = 3.1–9.3) that of the post-intervention participants. In conclusion, this study provides evidence that a simple intervention can meaningfully reduce the magnitude of microscopy-based misdiagnosis of malaria for those individuals seeking treatment for uncomplicated malaria. We anticipate that this intervention will facilitate a valuable and sustainable change in malaria diagnosis at the local hospital.

Author Biographies

Lisa K. Allen, University of Calgary
Department of Community Health Sciences
Jennifer M Hatfield, University of Calgary
Department of Community Health Sciences
Mange J. Manyama, Catholic University of Health and Allied Sciences, Mwanza
Department of Anatomy and Cell Biology
Published
2013-01-18
How to Cite
AllenL. K., HatfieldJ. M., & ManyamaM. J. (2013). Reducing microscopy-based malaria misdiagnosis in a low-resource area of Tanzania. Tanzania Journal of Health Research, 15(1). https://doi.org/10.4314/thrb.v15i1.4
Section
Articles

Journal Identifiers


eISSN: 1821-9241
print ISSN: 1821-6404