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Household cost of malaria overdiagnosis in rural Mozambique

Hume, Jen C.C, Barnish, Guy, Mangal, T., Armazio, L., Streat, E. and Bates, Imelda ORCID: (2008) 'Household cost of malaria overdiagnosis in rural Mozambique'. Malaria Journal, Vol 7, Issue 33.

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Background: It is estimated that over 70% of patients with suspected malaria in sub-Saharan Africa, diagnose and manage their illness at home without referral to a formal health clinic. Of those patients who do attend a formal health clinic, malaria overdiagnosis rates are estimated to range between 30-70%.
Methods: This paper details an observational cohort study documenting the number and cost of repeat consultations as a result of malaria overdiagnosis at two health care providers in a rural district of Mozambique. 535 adults and children with a clinical diagnosis of malaria were enrolled and followed over a 21 day period to assess treatment regimen, symptoms, number and cost of repeat visits to health providers in patients misdiagnosed with malaria compared to those with confirmed malaria (determined by positive bloodfilm reading).
Results: Diagnosis based solely on clinical symptoms overdiagnosed 23% of children (< 16y) and 31% of adults with malaria. Symptoms persisted (p = 0.023) and new ones developed (p < 0.001) in more adults than children in the three weeks following initial presentation. Adults overdiagnosed with malaria had more repeat visits (67% v 46%, p = 0.01-0.06) compared to those with true malaria. There was no difference in costs between patients correctly or incorrectly diagnosed with malaria. Median costs over three weeks were $0.28 for those who had one visit and $0.76 for >= 3 visits and were proportionally highest among the poorest (p < 0.001)
Conclusion: Overdiagnosis of malaria results in a greater number of healthcare visits and associated cost for adult patients. Additionally, it is clear that the poorest individuals pay significantly more proportionally for their healthcare making it imperative that the treatment they receive is correct in order to prevent wastage of limited economic resources. Thus, investment in accurate malaria diagnosis and appropriate management at primary level is critical for improving health outcomes and reducing poverty.

Item Type: Article
Uncontrolled Keywords: economic cost sri-lanka tanzania
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
W General Medicine. Health Professions > W 74 Medical economics. Health care costs
W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
WB Practice of Medicine > Therapeutics > WB 327 Self care
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WB Practice of Medicine > Medical Climatology > WB 710 Diseases of geographic areas
WB Practice of Medicine > Diagnosis > General Diagnosis > WB 200 Physical diagnosis (General)
WA Public Health > Health Administration and Organization > WA 525 General works
Faculty: Department: Groups (2002 - 2012) > Disease Control Strategy Group
Digital Object Identifer (DOI):
Depositing User: Tina Bowers
Date Deposited: 24 Jun 2010 10:18
Last Modified: 22 Oct 2019 08:20


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