Rapid ReviewMalaria misdiagnosis: effects on the poor and vulnerable
Section snippets
Misdiagnosis of malaria
In Africa over 70% of malaria cases do not present initially to health facilities but diagnose and manage their “malaria” (ie, fever) at home with traditional remedies or drugs bought from local shops. They only attend health centres after self-treatment fails, and even then they do not receive a good-quality diagnosis.6 At peripheral health facilities a diagnosis of malaria is based solely on clinical features such as fever. Although this approach can reduce morbidity,7 many infectious
Disproportionate effect on poor and vulnerable
The poor are less likely to seek western medical care for treatment of fevers than the more wealthy, leading to delays in diagnosis and treatment and more advanced disease (Worrall E, Basu S, Hanson K, London School of Hygiene and Tropical Medicine, personal communication). If this situation is compounded by inaccurate diagnoses, confidence in allopathic health services will be lost in favour of traditional healers. The belief that these providers can treat complicated malaria will be
Implications for public-health and health systems
Malaria-endemic countries have economic growth rates that are 1·3% lower than countries without malaria.13 The gap in prosperity between these groups of countries is widening every year and it is predicted that malaria cases will double over the next 20 years.17, 18 In many countries patients pay for health services, including consultations, laboratory tests, and drugs. These cost-recovery measures have driven the poorest away from allopathic health services and increased self-medication.19 To
Conclusion
With the introduction of antimalarial drugs that are more expensive and toxic than traditional, but failing, monotherapies, it will be unethical for health professionals to condone the current level of malaria misdiagnosis. The balance between the risk of wrong diagnosis and use of antimalarial drugs might be acceptable when drugs are safe and cheap, but with more expensive and less safe drug regimens it is more cost effective to improve the accuracy of malaria diagnosis.22 The effect of
References (22)
- et al.
Overlap in the clinical features of pneumonia and malaria in African children
Trans R Soc Trop Med Hyg
(1993) - et al.
Dihydroartemisinin-piperaquine against multidrug-resistant Plasmodium falciparum malaria in Vietnam: randomised clinical trial
Lancet
(2004) - et al.
A community-based programme to provide prompt and adequate treatment of presumptive malaria in children
Trans R Soc Trop Med Hyg
(1997) - et al.
Household cost of seeking malaria care
Soc Sci Med
(1997) Disease classification in rural Ghana
Social Sc Med Part B: Med Anthropol
(1981)Are people willing and able to pay for health services?
Soc Sci Med
(1989)- et al.
Symptom overlap for malaria and pneumonia
Acta Trop
(2004) - et al.
Drug combinations for malaria: time to ACT?
Lancet
(2004) Artesunate combinations for treatment of malaria: meta-analysis
Lancet
(2004)- et al.
Use of clinical algorithms for diagnosing malaria
Trop Med Int Health
(2002)