Low reliability of home-based diagnosis of malaria in a rural community in western Kenya

Abstract

Introduction:  Home-based management of malaria is promoted as a major strategy for improving prompt delivery of effective malaria treatment in Africa. This study aimed to determine the proportion of children who tested positive for malaria with routine light microscopy among those whose mothers had made a home-based diagnosis in a rural community in Western Kenya.

Methodology: This cross-sectional study was conducted at Bokoli location, Bungoma East District in November and December 2007. Mothers of children five years of age or under with malaria diagnosed by their mothers were interviewed (n = 96). Duplicate blood smears were collected, stained by field stain A (Methylene blue, Azure) and B (Eosin), and examined for malaria parasites using light microscopy.

Results: Only 30/96 (31.2%) specimens were positive for Plasmodium falciparum. Elevated temperature (70/96; 72.9%) in their children was the most commonly cited criterion for diagnosis of malaria by the mothers. In 57 of the 96 cases, information was given by the mothers regarding treatment during the current malaria episode; of these, 10 (17.5%) had received treatment for malaria, but six (60%) of these were parasite negative. This means that only 4/21 (19.0%) with positive smear microscopy received treatment. The most common anti-malaria drugs used were Fansidar (37.8%) and Metakelfin (29.7%).

Conclusion: The difficulty of diagnosing malaria accurately at home increases the urgent need for improved diagnostic tools that can be used at the community level in poor populations. Intervention measures are needed to increase the treatment rate to reduce reservoirs and malaria parasite transmission.