Overdiagnosis and Overtreatment of Malaria in Children That Presented with Fever in Lagos, Nigeria

Abstract

Background . Malaria diagnosis has been largely done clinically. The implication is the likely overdiagnosis of malaria when diagnosis is done soley on the basis of symptoms. Methods . Parasitological diagnosis was done among 1211, 0–12 years old febrile children that attended a Primary Health Centre in Lagos, Nigeria, who were diagnosed clinically and treated based on symptoms. Results . A total of 251 of 1,211 (20.7%) children less than 12 years old and 174 of the 1,027 of children 0–≤5 yrs (16.9%) were slide positive while 853 (83.1%) of 0–≤5 yrs that were slide negative were treated with Artemisinin based combination therapies (ACTs) in line with the Integrated Management of Childhood Infectioins (IMCI) guidelines and standard practice of the Clinic. Chills, diarrhoea, convulsions, headache, cough, respiratory distress, inactivity, loss of apetite, and vomiting occured significantly in the 0–≤5 and >5–12 years old malaria negative children. Conclusions . Overdiagnosis and overtreatment of malaria in this study was high. Therefore, malaria medicines should be prescribed on the basis of parasitological confirmation of all suspected malaria cases. The availability of quality-assured malaria rapid diagnostic tests (RDTs) is a useful tool to confirm malaria cases while the cause of the non-malaria fevers can be followed up and managed appropriately.