Malaria case management: assessment of the existing diagnostic practices and implications in prioritizing malaria control in Ilala municipal health plan

The findings of this study show that malaria is still a major public health problem. It is the leading cause of out-patient attendances, (34%). This finding is similar to the National figure of (33%), Ministry of Health, Statistics Abstract (1998). Fever history was the main symptom that determined clinical diagnosis. Proper history taking and physical examination for specific symptoms to rule out other causes of fever was elicited in less than a third of the patients. Laboratory tests to confirm malaria parasitaemia was done in only 31% of patients. Even in these patients the results did not change the management. Chloroquine was the drug prescribed most (97%) although fansidar, quinine and metakelfin were also prescribed. About 50% of mothers of the sick children seek treatment within 48 hours of the start of symptoms, while adults delayed seeking treatment. Fever (hot body) in a child appeared to be of concern to mothers, and probably this was the reason for seeking treatment earlier. Delay in seeking treatment in adults may be attributed to self-medication and was reported by the majority. Delay in getting blood slide results as well as getting treatment, (46%) was reported by patients as main reasons for dissatisfaction. We suggest that the improved malaria diagnosis may be cost-effective especially where chloroquine is no longer the first line anti-malarial. The improvement in diagnosis will lead to restricted use of anti-malarial and to sustain efficacy.