Does the availability of blood slide microscopy for malaria at health centers improve the management of persons with fever in Zambia?

Some Ministries of Health in Africa plan to make blood slide microscopy ava ilable in peripheral health centers to improve malaria diagnosis over the c urrent practice, which relies solely on clinical findings. To assess whethe r microscopy improves the management of febrile persons in health centers, we prospectively reviewed medical records of all outpatients visiting six h ealth centers with laboratories in Zambia during a 2-3-day period. Staff in terviews and a blinded review of a series of blood slides from each facilit y by two expert microscopists were also conducted. Of 1,442 outpatients, 65 5 (45%) reported fevers or had a temperature greater than or equal to 37.5 degrees C. Blood slide microscopy was ordered in 28-93% of patients with fe ver (mean = 46%). Eighty-eight (35%) patients without parasitemia were pres cribed an antimalarial drug. Antimalarial drugs were prescribed with equal frequency to those who were referred for a blood slide (56%) and those not referred (58%). The sensitivity of microscopy was 88% and the specificity w as 91%. Use of malaria microscopy varied widely, indicating that clinicians an not using standard criteria for ordering this test. Although diagnosis by microscopy was generally accurate, it appeared to have had little impact on the treatment of persons with fever. Guidelines for using blood slide m icroscopy are needed and prescription of antimalarial drugs should be disco uraged when slide results are negative.