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Accuracy of Malaria Diagnosis by Microscopy, Rapid Diagnostic Test, and PCR Methods and Evidence of Antimalarial Overprescription in Non-Severe Febrile Patients in Two Tanzanian Hospitals

The study was aimed to evaluate the malaria over/underdiagnosis and over/underprescription of antimalarial drugs. Between February and March 2007 blood samples were collected from 336 non-severe febrile outpatients attended in two peripheral Tanzanian hospitals. Microscopy and a rapid diagnostic test (RDT) were done locally and the accuracy evaluated by qualitative polymerase chain reaction (PCR) for Plasmodium spp. The testing was performed at National Institute for Infectious Diseases Lazzaro Spallanzani (INMI), Rome, Italy. As a result of PCR, we identified 26 malaria cases out of 336 (7.7%) patients. Microscopy and RDT accuracies were 93.5% and 97.6%, respectively. Overprescription and underdiagnosis rates were 29.3% and 30.8%, respectively. On-field training, clinical management of febrile illness, and malaria microscopy in remote settings should be considered.

Received April 28, 2008. Accepted for publication January 10, 2009.

Acknowledgments: We thank the Ministry of Health of United Republic of Tanzania and the Ministry of Health of Zanzibar for allowing the access to malaria patients and the patients for participating in the study. The National Institute for Infectious Diseases L. Spallanzani (INMI) is grateful to Dr. Valerie D’Acremont for helpful discussions and constructive advises. The American Society of Tropical Medicine and Hygiene (ASTMH) assisted with publication expenses.

Financial support: This work was part of the activities carried out by the Programme Aid 8282 in Tanzania, funded by the Italian Cooperation and Ministry of Foreign Affairs of Italy. The American Society of Tropical Medicine and Hygiene (ASTMH) assisted with publication expenses.

^* Address correspondence to Nazario Bevilacqua, National Institute for Infectious Diseases Lazzaro Spallanzani, Via Portuense 292, 00149 Rome, Italy. E-mail: bevilacqua{at}inmi.it

Authors’ addresses: Emanuele Nicastri, Monica Sañé Schepisi, Maria G. Paglia, Silvia Meschi, Antonino Di Caro, Maria R. Capobianchi, and Giuseppe Ippolito, National Institute for Infectious Diseases Lazzaro Spallanzani, Via Portuense 292, 00149 Rome, Italy. Nazario Bevilacqua, National Institute for Infectious Diseases Lazzaro Spallanzani, Via Portuense 292, 00149 Rome, Italy, Tel: +39 06 55170465, Fax: +39 06 55170413, E-mail: bevilacqua{at}inmi.it. Shaali M. Ame and Jape A. Mohamed, Public Health Laboratory–Ivo De Carneri, P.O. Box 122, Chake Chake, Pemba Island, Zanzibar, Tanzania. Sabina Mangi and Robert Fumakule, Tosamaganga Hospital, Iringa, P.O. Box 11, United Republic of Tanzania. Andrew Kitua, National Institute for Medical Research General Director, Dar es Salaam, United Republic of Tanzania. Fabrizio Molteni and Vincenzo Racalbuto, Italian Cooperation, Italian Ministry of Foreign Affairs, Rome, Italy.