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LOW RELIABILITY OF HOME-BASED DIAGNOSIS OF MALARIA IN A RURAL COMMUNITY IN WESTERN KENYA

LOW RELIABILITY OF HOME-BASED DIAGNOSIS OF MALARIA IN A RURAL COMMUNITY IN WESTERN KENYA Rose Kakai (1), Josephine Nasimiyu (2), 1 Wilson Odero (1) 1 Maseno University, Kenya 2 Bokoli Health Centre, Kenya. Introduction Malaria is one of the most severe public health problems.

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LOW RELIABILITY OF HOME-BASED DIAGNOSIS OF MALARIA IN A RURAL COMMUNITY IN WESTERN KENYA

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  1. LOW RELIABILITY OF HOME-BASED DIAGNOSIS OF MALARIA IN A RURAL COMMUNITY IN WESTERN KENYA Rose Kakai (1), Josephine Nasimiyu (2), 1Wilson Odero (1) 1 Maseno University, Kenya 2 Bokoli Health Centre, Kenya 267

  2. Introduction • Malaria is one of the most severe public health problems. • Severe malaria is associated with delay of presentation at a health facility and late use of anti-malarial drugs [Dunyo et. al. 2000, Sumba et. al. 2008]. • WHO recommends that anyone suspected of having malaria should receive dx and Rx with an effective drug within 24 hrs of onset of symptoms [WHO 2005] • Definitive dx is based on identifying plasmodia in blood films. • However, presumptive treatment without lab ddx has been justified by the scarcity of clinical facilities and the high case fatality rate of malaria in high-prevalence areas. 267

  3. Introduction ............ • Consequently, home Rx is acceptable when the patient does not have prompt access to a health-care provider, as is the case for most patients in malaria-endemic areas [WHO 2004,Foster 1995]. • Even though febrile illnesses are commonly treated at home, little attention has been paid to the children’s caretakers’ Dx of malaria in the community against lab microscopy. 267

  4. Objective • To determine the proportion of children who tested positive for malaria with routine light microscopy among those whose mothers had made a home-based Dx in a rural community in Western Kenya. 267

  5. Methods • Study setting • The study was conducted in Bokoli sub-location, Bokoli location, Webuye division of Bungoma East District, Western Kenya. • The area is located near the equator, ≈ 100 km north of Lake Victoria. • Malaria is the main cause of patients presenting at the local health centre, with a prevalence of ≈ 30% against clinical diagnosis (Medical records, 2006). 267

  6. Study design • A community-based cross-sectional study. • Data collection and analysis • From every consecutive household, mothers of children < 5 yrs of age with malaria as diagnosed by their mothers were interviewed (n = 96), to elicit responses regarding age, educ level, malaria Dx and Rx. • Duplicate blood smears were collected, stained by field stain A (Methylene blue, Azure) and B (Eosin), and examined using microscopy for presence of malaria parasites • Mothers < 18 yrs old and those who did not give consent to participate were excluded. • Data was analyzed using descriptive statistics. Association between microscopy and home-based diagnosis was established using chi-square test. 267

  7. Results • 96 children included in study, mean age was 25.6 months. • Malaria parasites were detected in only 30/96 (31.2%) of the specimens. All cases were Plasmodium falciparum (Table 1). • Elevated temp was the most common criterion for diagnosis of malaria cited by 70/96 (72.9%) mothers. • There was no significant association between the mothers’ age or education level and malaria diagnosis (p = 0.58 and 0.46, respectively). 267

  8. Table I: Maternal age and education level against blood smear results 267 * = 9 women did not give their ages

  9. Figure 1: Children’s age versus mother’s clinical diagnosis against P. facliparum blood smear positive results • There was a statistically non-significant trend for a decrease in malaria-pos cases by microscopy as the age of the children increased upto 36m, after which it was reversed upward to stabilize at about 30% (p = 0.51) (Fig. 1). 267

  10. Table II: Malaria diagnosis against treatment • 57 of the 96 mothers gave information regarding treatment during the current malaria episode; of these, 10 (17.5%) had received treatment for malaria, but 6 (60%) of these were parasite negative (Table II). • This means that only 4/21 (19.0%) with positive smear microscopy received treatment (p=0.05). • The most common anti-malaria drugs used were Fansidar (37.8%) and Metakelfin (29.7%). 267

  11. Conclusions • Mothers correctly diagnosed malaria in only about one-third of the cases. • Health-care providers’ Dx was similar to that of the mothers. • Home-based Dx was independent of maternal age and level of educ. • Specific Rx rates were extremely low. Many (80%) cases with smear-pos microscopy had not received any Rx. • Malaria is overestimated in our study area if the Dx is based solely on clinical signs, therefore lab confirmation is essential. • Policy implications • The difficulty of diagnosing malaria accurately at home increases the urgent need for improved diagnostic tools that can be used at the community level in poor populations. • Intervention measures are needed to increase the Rx rate to reduce reservoirs and malaria parasite transmission. 267

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