There is a problem of overdiagnosis and mistreatment of malaria in south and central Asia, researchers warn today.
Malaria is still one of the most common infectious diseases linked with poverty. Guidelines recommend giving anti-malaria drugs only once a diagnostic test has positively identified malaria parasites in the blood. But in Africa, patients are often given the drugs after a negative result, which wastes drugs and causes other severe infections to be missed.
Dr Toby Leslie of the London School of Hygiene and Tropical Medicine, UK, and colleagues investigated the issue in south and central Asia. They took figures from 2,357 patients with suspected malaria attending 22 clinics in two Afghan provinces with high malaria risk.
Prescriptions were given to 99 per cent of individuals proved negative by the researchers at the centres which relied on clinical diagnosis alone. At the clinics using the new test, 37 to 51 per cent of patients who were negative for the parasite nevertheless received a malaria drug. Rates of antibiotic use varied but were fairly high at all centres.
Full results are published by the British Medical Journal today (July 25). In conclusion, the authors write: "Fever was substantially misdiagnosed as malaria in this south Asian setting.
"This inaccuracy was attributable to false positive laboratory diagnoses of malaria and the clinicians’ disregard of negative slide results. Rare but potentially fatal cases of falciparum malaria were not detected, emphasising the potential role of rapid diagnostic tests."
They add: "Microscopy increased the proportion of patients treated with antibiotics producing a trade-off between overtreatment with malaria drugs and probable overtreatment with antibiotics."
These results are similar to findings from Africa, confirming that inaccurate diagnosis and treatment of malaria is a worldwide problem, say the team.
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