The importance of correct malaria diagnostics
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Despite the existence of effective tools for the prevention and treatment of malaria, malaria still causes an estimated one million deaths a year, mainly among children in sub-Saharan Africa.
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| Dr Martin De Smet [MSF] |
Scaling up malaria preventative activities, through the increased use of bed nets and providing efficacious treatment in the form of artemisinin-based combination therapy (ACT), has been high on the agenda for the past few years. However, implementation of these interventions remains a huge challenge for the future. It is estimated that only one-in-five children suffering from malaria have access to ACT, and only one-in-four children living in endemic countries sleeps under an insecticide-treated bed net.
Until recently, little attention had been given to the importance of accurate malaria diagnosis. Accurate diagnosis with microscopy or rapid diagnostic tests ensures that a correct diagnosis is made and that a patient receives the correct treatment. In the presence of a negative result, the unnecessary administration of ACT is avoided.
In many African countries where malaria is endemic, patients who present with a fever are often routinely considered to have malaria and are treated as such, without any biological confirmation of the diagnosis. This is especially the case for children in high transmission areas. And yet, reliable, easy-to-use and relatively cheap Rapid Diagnostic Tests (RDT) are available, that can confirm malaria within 15 minutes using one drop of blood from a patient's finger. These tests are a more feasible alternative to microscopy, which although very useful, requires greater expertise, more advanced equipment and requires more time before a result can be obtained.
Today, routinely treating patients with fever for "suspected" malaria is no longer deemed acceptable. MSF experience has shown that a significant proportion of patients with suspected malaria actually are not suffering from malaria (in most MSF projects this is between 40-50% of patients, ranging from 30% in high endemic areas - such as the project site in Mali - to more than 90% in Sudan and Somalia).
Confirming a malaria diagnosis is important for a number of reasons, not least to ensure that the patient receives the correct treatment. A patient with fever who tests negatively for malaria should be further evaluated and treated for the real cause of the fever. Among children for instance, fever maybe due to a respiratory tract infection, which is often the second leading cause of death in children. A diagnosis that excludes malaria as the cause of fever can help doctors to better identify and target the treatment for other diseases.
