Role of rapid diagnostic tests for guiding outpatient treatment of febrile illness in Liaquat University Hospital

OBJECTIVES To assess the validity /strength of clinical diagnosis of Malaria on the basis of IMNCI algorithm by slide microscopy (gold standard) and to compare the effectiveness of Rapid Diagnostic Test (RDT )against slide microscopy. Methods : It is a descriptive cross sectional study of 6 month duration conducted at Pediatric Outpatient Department LUH Hyderabad from June-Dec. 2010. Sample of 400{the minimum required sample was 385 with malaria prevalence 5% (0.05) with margin of error of 3% (0.03, frequency vary from 2-8 % among different studies)} febrile children under 5 years classified as Suspected Clinical Malaria according to algorithm of IMNCI were included; The operational definition for Suspected Clinical Malaria was; fever for more than 2 days with no runny nose, no measel rash and no other cause of fever. Hyderabad was considered as low risk area. Rapid diagnostic test (RDT) and slide microscopy were done, and only confirmed cases were treated according to current guidelines given by National Malaria Program/updated IMNCI. RESULTS Total 2000 patients under 5 years presented with fever and were evaluated. From 2000 cases 20% (400) were diagnosed as suspected clinical Malaria according to IMNCI algorithm; and only 40 cases (10%) have shown positive results for malaria parasite on slide microscopy and 38 cases on RDT. Regarding the plasmodium species 70% were vivax and 30% were falciparum. As regards the effectiveness, RDT has shown 95% sensitivity for the detection of plasmodium antigens in the febrile clinically suspected cases of malaria. CONCLUSION Prompt and accurate diagnosis of malaria is needed for implementation of appropriate treatment to reduce unnecessary anti-malarial prescription. RDT is as effective as slide microscopy for the diagnosis of malaria especially in resource poor countries.