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Household cost of malaria overdiagnosis in rural Mozambique.

Hume JC, Barnish G, Mangal T, Armázio L, Streat E, Bates I - Malar. J. (2008)

Bottom Line: Symptoms persisted (p = 0.023) and new ones developed (p < 0.001) in more adults than children in the three weeks following initial presentation.Additionally, it is clear that the poorest individuals pay significantly more proportionally for their healthcare making it imperative that the treatment they receive is correct in order to prevent wastage of limited economic resources.Thus, investment in accurate malaria diagnosis and appropriate management at primary level is critical for improving health outcomes and reducing poverty.

View Article: PubMed Central - HTML - PubMed

Affiliation: Disease Control Strategy Group, Liverpool School of Tropical Medicine, Liverpool, UK. humej@niaid.nih.gov

ABSTRACT

Background: It is estimated that over 70% of patients with suspected malaria in sub-Saharan Africa, diagnose and manage their illness at home without referral to a formal health clinic. Of those patients who do attend a formal health clinic, malaria overdiagnosis rates are estimated to range between 30-70%.

Methods: This paper details an observational cohort study documenting the number and cost of repeat consultations as a result of malaria overdiagnosis at two health care providers in a rural district of Mozambique. 535 adults and children with a clinical diagnosis of malaria were enrolled and followed over a 21 day period to assess treatment regimen, symptoms, number and cost of repeat visits to health providers in patients misdiagnosed with malaria compared to those with confirmed malaria (determined by positive bloodfilm reading).

Results: Diagnosis based solely on clinical symptoms overdiagnosed 23% of children (<16y) and 31% of adults with malaria. Symptoms persisted (p = 0.023) and new ones developed (p < 0.001) in more adults than children in the three weeks following initial presentation. Adults overdiagnosed with malaria had more repeat visits (67% v 46%, p = 0.01-0.06) compared to those with true malaria. There was no difference in costs between patients correctly or incorrectly diagnosed with malaria. Median costs over three weeks were $0.28 for those who had one visit and $0.76 for > or = 3 visits and were proportionally highest among the poorest (p < 0.001)

Conclusion: Overdiagnosis of malaria results in a greater number of healthcare visits and associated cost for adult patients. Additionally, it is clear that the poorest individuals pay significantly more proportionally for their healthcare making it imperative that the treatment they receive is correct in order to prevent wastage of limited economic resources. Thus, investment in accurate malaria diagnosis and appropriate management at primary level is critical for improving health outcomes and reducing poverty.

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Providers of health care for A. children (N = 108) and B. adults (N = 56) with clinical diagnosis of malaria who sought additional health interactions over the 21-day study period.
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Figure 1: Providers of health care for A. children (N = 108) and B. adults (N = 56) with clinical diagnosis of malaria who sought additional health interactions over the 21-day study period.

Mentions: The number of times individuals sought any HI during the 21 days after their initial visit varied from 0 (47%; 146/312 individuals) to nine (one individual). For the 53% of patients who had more than one HI, the median number of attendances was two (Table 3). 54% of children had one or more HIs with no difference in frequency between those with or without microscopy confirmed malaria (p = 0.879, maximum likelihood estimation with adjustment for overdispersion). 46% of adults with microscopy confirmed malaria had ≥ 1 HIs compared to 67% who were misdiagnosed with malaria (p = 0.01–0.06, maximum likelihood estimation with adjustment for overdispersion). The number of HIs by participants who had malaria confirmed by microscopy were also analysed according to whether they received anti-malarial treatment at day 0 or not. There was no difference in HIs between the treated and untreated group for children or adults. Although most repeat health interactions occurred at the original health clinic (61% by adults and 73% by children), 26% of interactions by adults and 24% by children took place at local shops or traditional medicine providers (Figure 1).


Household cost of malaria overdiagnosis in rural Mozambique.

Hume JC, Barnish G, Mangal T, Armázio L, Streat E, Bates I - Malar. J. (2008)

Providers of health care for A. children (N = 108) and B. adults (N = 56) with clinical diagnosis of malaria who sought additional health interactions over the 21-day study period.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2279141&req=5

Figure 1: Providers of health care for A. children (N = 108) and B. adults (N = 56) with clinical diagnosis of malaria who sought additional health interactions over the 21-day study period.
Mentions: The number of times individuals sought any HI during the 21 days after their initial visit varied from 0 (47%; 146/312 individuals) to nine (one individual). For the 53% of patients who had more than one HI, the median number of attendances was two (Table 3). 54% of children had one or more HIs with no difference in frequency between those with or without microscopy confirmed malaria (p = 0.879, maximum likelihood estimation with adjustment for overdispersion). 46% of adults with microscopy confirmed malaria had ≥ 1 HIs compared to 67% who were misdiagnosed with malaria (p = 0.01–0.06, maximum likelihood estimation with adjustment for overdispersion). The number of HIs by participants who had malaria confirmed by microscopy were also analysed according to whether they received anti-malarial treatment at day 0 or not. There was no difference in HIs between the treated and untreated group for children or adults. Although most repeat health interactions occurred at the original health clinic (61% by adults and 73% by children), 26% of interactions by adults and 24% by children took place at local shops or traditional medicine providers (Figure 1).

Bottom Line: Symptoms persisted (p = 0.023) and new ones developed (p < 0.001) in more adults than children in the three weeks following initial presentation.Additionally, it is clear that the poorest individuals pay significantly more proportionally for their healthcare making it imperative that the treatment they receive is correct in order to prevent wastage of limited economic resources.Thus, investment in accurate malaria diagnosis and appropriate management at primary level is critical for improving health outcomes and reducing poverty.

View Article: PubMed Central - HTML - PubMed

Affiliation: Disease Control Strategy Group, Liverpool School of Tropical Medicine, Liverpool, UK. humej@niaid.nih.gov

ABSTRACT

Background: It is estimated that over 70% of patients with suspected malaria in sub-Saharan Africa, diagnose and manage their illness at home without referral to a formal health clinic. Of those patients who do attend a formal health clinic, malaria overdiagnosis rates are estimated to range between 30-70%.

Methods: This paper details an observational cohort study documenting the number and cost of repeat consultations as a result of malaria overdiagnosis at two health care providers in a rural district of Mozambique. 535 adults and children with a clinical diagnosis of malaria were enrolled and followed over a 21 day period to assess treatment regimen, symptoms, number and cost of repeat visits to health providers in patients misdiagnosed with malaria compared to those with confirmed malaria (determined by positive bloodfilm reading).

Results: Diagnosis based solely on clinical symptoms overdiagnosed 23% of children (<16y) and 31% of adults with malaria. Symptoms persisted (p = 0.023) and new ones developed (p < 0.001) in more adults than children in the three weeks following initial presentation. Adults overdiagnosed with malaria had more repeat visits (67% v 46%, p = 0.01-0.06) compared to those with true malaria. There was no difference in costs between patients correctly or incorrectly diagnosed with malaria. Median costs over three weeks were $0.28 for those who had one visit and $0.76 for > or = 3 visits and were proportionally highest among the poorest (p < 0.001)

Conclusion: Overdiagnosis of malaria results in a greater number of healthcare visits and associated cost for adult patients. Additionally, it is clear that the poorest individuals pay significantly more proportionally for their healthcare making it imperative that the treatment they receive is correct in order to prevent wastage of limited economic resources. Thus, investment in accurate malaria diagnosis and appropriate management at primary level is critical for improving health outcomes and reducing poverty.

Show MeSH
Related in: MedlinePlus