To determine factors influencing laboratory diagnosis of malaria in Lindi region hospitals, 2012

Abstract

Background; Malaria remains an important public health problem. Globally it accounts for 219 Million cases and 660,000 deaths, majority under 5 years. Africa continent contributing 90% of all deaths, it is estimated that, malaria accounts for 50% of outpatient, 20% of admissions in Sub Saharan Africa. Tanzania reporting 120,000 patients annually of whom 80,000 occur in children bellow 5 years of age. This study was carried out to determine factors influencing laboratory diagnosis of malaria in hospitals. Methods; Cross sectional quantitative study conducted from October to December 2012 in three Hospitals, Lindi Region. Patients, clinician and laboratory personnel were interviewed for their practice and quality of malaria patient management. Two thick blood smears were collected from patients, stained and examine by laboratory technologist at the study site and Bagamoyo – Ifakara research institute Laboratory. Results: Total of 479 patients, 28 clinicians and 17 laboratory personnel were recruited, Patients mean age was 25 years ±STDev 23years, Female 288 (60.1%), Male 191 (39.9%). Clinicians mean age was 38 yrs ±STDev 10.5 years, Female 16 (57.1%) Male 12 (42.9 %) Laboratory personnel, mean age was 25 years ±STDev 10.4 years, Female 2 (11.8 %), Male 15(88.2%). Among 479 patients tested for malaria, 42 (8.8%) were positive for malaria compared to 20 (4.2%) obtained from reference laboratory with 33.3% PPV 94% NPV. Of the 17 laboratory personnel, 52% had no form of continue education in the field of malaria. There is only 26.3% of the required staff in the study area. Good prepared smear were 1.7 times likely to have given the correct results, while good staining were more likely to give correct results (P value 0.01), Correct smear microscopy was more probable to be reported by that technician who cleaned microscope before use (P value <0.001). Though 60.7% of clinicians mentioned to trust laboratory results; 4.6% of patients were given antimalarial prior laboratory test and 26.3% treated based on clinical diagnosis regardless of smear negative result.

Conclusion and Recommendations; Malaria Laboratory results are more likely to be compromised by inadequate trained and over-worked laboratory personnel. Laboratory results contribute little to the patients’ management. Skilled staff could improve laboratory results and hence patient management.