Diagnostic accuracy and case management of clinical malaria in the primaryhealth services of a rural area in south-eastern Tanzania

Malaria control continues to rely on the diagnosis and prompt treatment of both suspected and confirmed cases through the health care structures. In s outh-eastern Tanzania malaria is one of the leading causes of morbidity and mortality. The absence of microscopic examination in most of the health fa cilities implies that health workers must rely on clinical suspicion to ide ntify the need of treatment for malaria. Of 1558 randomly selected paediatr ic consultations at peripheral health facilities throughout Kilombero Distr ict, 41.1% were diagnosed by the attending health worker as clinical malari a cases and 42.5% prescribed an antimalarial. According to our malaria case definition of fever or history of fever with asexual falciparum parasitaem ia of any density, 25.5% of all children attending the health services had malaria. This yielded a sensitivity of 70.4% (IC95% = 65.9-74.8%) and a spe cificity of 68.9% (IC95% = 66.2-71.5%). Accordingly, 30.4% of confirmed cas es left with no antimalarial treatment. Among malaria-diagnosed patients, 1 0% were underdosed and 10.5% were overdosed. In this area, as in many Afric an rural areas, the low diagnostic accuracy may imply that the burden of ma laria cases may be overestimated. Greater emphasis on the functioning and q uality of basic health services in rural endemic areas is required if impro ved case management of malaria is to help roll back this scourge.