Evalutation of malaria infection in relation to age, residence and diagnosis of patients attending Kipsamoite dispendary, Nandi North District, Kenya

Abstract

Malaria imposes a huge burden upon the health and economic development of tropical nations and has been identified as a major obstacle to sustainable development by the world's poorest regions. Diagnosis of malaria still remains a major challenge towards effective case management more so in areas with limited diagnostic facilities and lack of access to skilled health personnel. Clinical diagnosis which is the most widely used approach has several limitations leading to its low sensitivity. This study was undertaken to evaluate the performance of clinical/mothers', caregivers/individuals' diagnosis of malaria infection using microscopy as the gold standard to determine the accuracy to support malaria case management. The disease distribution in relation to age and residence among patients attending Kipsamoite Dispensary in Nandi North district was also assessed to inform control decision making. A total of 349 patients who visited the facility during the study period were recruited. Clinical Diagnosis criteria classified 349/349 (100%) as having malaria while mothers'/caregivers'/individuals' diagnosis classified 214/349 (61.3%) as having malaria. Microscopy detected 113/349(32.4%) as positive for malaria Parasite density distribution was analyzed by one way analysis of variance (ANOVA).). There was no significant difference in mean parasite density distribution across the seven residential area categories (P=0.261). The study revealed a statistically significant association between the body temperature and malaria infection (P< 0.001). Distribution of malaria infection in the study population was analyzed by age group (<5and >5 years) using Pearson Chi-square test. The infection distribution was significantly associated with age group; (P<0.05). The combination of mothers' / care givers' / individuals' and clinical against microscopy improved the positive predictive value (PPV) of malaria diagnosis from 32.4% to 36.8%. Malaria infection was neither associated with residential areas nor parasite density but significantly associated with body temperature. The observations of this study suggest that clinical diagnosis is less sensitive compared to mothers'/ carers' or individuals' malaria diagnosis. There is need to improve on clinical diagnostic criteria to progress on its performance and to train and encourage mothers/caregivers/individuals on clinical symptoms of malaria to improve home management of malaria with a view to achieving the Abuja targets of Roll Back Malaria (RBM).