Evaluation of laboratory diagnosis of malaria in government health facilties in selected epidemic prone districts in Northern and Southern rift valley Kenya

Abstract

Malaria is a disease in the tropics posing as a major obstacle to sustainable development. The malaria burden mainly rests in sub-Saharan Africa where it kills one in five children under five years and act in synergy with other illnesses like respiratory infections, diarrhoeal diseases and malnutrition to cause childhood morbidity and mortality. Prevention and control of malaria deaths can be achieved if the disease is promptly and correctly diagnosed and treated. The new national guidelines for diagnosis, treatment and prevention for malaria in Kenya underscore the need for laboratory confirmation of malaria parasites before treatment. Thus, accurate laboratory diagnosis of malaria will play a pivotal role in treatment and prevention of malaria. However, in Kenya, there is no information on the accuracy of laboratory diagnosis of malaria in Government health facilities. The current study was aimed at evaluating the status of laboratory diagnosis of malaria in Government health facilities. The study was carried out in eight malaria epidemic prone districts, which included: Uasin Gishu, Nandi North, Lugari, West Pokot, Narok, Kisii, Kericho and Trans Mara. A cross-sectional study was done on suspected cases of malaria in the facilities in the eight districts. The study was done immediately after the long and short rains in the months of May and November 2007. Purposive sampling was done and a total of 3034 suspected cases of malaria were screened. Fingerpick was done and thick and thin blood smears made, stained by Giemsa and examined under power xl 00 magnification. All positive and negative results of malaria were recorded and for comparison, malaria cases examined two weeks prior to this study were obtained from the laboratory records. The total number of malaria cases detected based on the retrieved records, two weeks before was seven fold higher than those recorded during the visits. The results obtained in this study during the visits and those got from the records two weeks prior to the visits were compared. The number of positive slides two weeks before this study was 2280 (20.1%) in April and 1659 (16.7%) in December,2007 as compared to 45 (2.8%) in April and 76 (4.8%) December respectively, obtained during current study. There was a seven and three fold decline in proportion of positive slides for malaria during the teams' visits in April and December respectively compared to the records for the two weeks preceding visits and the difference was significant(P<O.OOI).Data obtained from this study suggests that there were problems associated with health personnel in malaria diagnosis. These were mainly, lack of proper or inadequate training on malaria diagnosis, inadequate personnel and poor attitude of clinical and laboratory personnel towards each other. Data obtained from the study suggest that refresher courses are necessary for both personnel on malaria diagnosis; good quality reagents and microscopes should be provided to all laboratories inGovernment health facilities. Regular external quality control is necessary and on-job training is required for the laboratory personnel in malaria diagnosis. This study suggests that there is need for a situational analysis to establish the extent of laboratory misreporting of malaria III all clinical laboratories across the country.