Health centre versus home presumptive diagnosis of malaria in southern Ghana: implications for home-based care policy

A study was conducted in 1997 to compare the accuracy of presumptive diagno sis of malaria in children aged 1-9 years performed by caretakers of the ch ildren to that of health centre staff in 2 ecological zones in southern Gha na. Similar symptoms were reported in the children at home and at the healt h centre. In the home setting, symptoms were reported the same day that the y occurred, 77.6% of the children with a report of fever were febrile (axil lary temperature greater than or equal to 37.5 degrees C) and 64.7% of the reports of malaria were parasitologically confirmed. In the health centre, the median duration of symptoms before a child was seen was 3 days (range 1 -14 days), 58.5% of the children with a report of fever were febrile and 62 .6% of the clinically diagnosed cases were parasitologically confirmed. In the 2 settings almost all the infections were due to Plasmodium falciparum. Parasite density was 3 times higher in the health centre cases compared to the home-diagnosed cases. Early and appropriate treatment of malaria detec ted in children by caretakers may prevent complications that arise as a res ult of persistence of symptoms and attainment of high parasitaemic levels.