Cost comparison of microscopy vs. empiric treatment for malaria in southwestern nigeria: a prospective studyReport as inadecuate




Cost comparison of microscopy vs. empiric treatment for malaria in southwestern nigeria: a prospective study - Download this document for free, or read online. Document in PDF available to download.

Malaria Journal

, 9:371

First Online: 22 December 2010Received: 06 July 2010Accepted: 22 December 2010

Abstract

BackgroundPresumptive treatment for malaria is common in resource-limited settings, yet controversial given the imprecision of clinical diagnosis. The researchers compared costs of diagnosis and drugs for two strategies: 1 empirical treatment of malaria via clinical diagnosis; and 2 empirical diagnosis followed by treatment only with Giemsa smear confirmation.

MethodsPatients with a diagnosis of clinical malaria were recruited from a mission-university teaching hospital in southwestern Nigeria. The patients underwent free Giemsa thick diagnosis and thin differentiation smears, but paid for all anti-malarial drugs. Clinical diagnosis was made on clinicians- judgments based on symptoms, including fever, diarrhoea, headache, and body aches. The paediatric regimen was artesunate 6-9 tablets of 3 mg-kg on day one and 1.5 mg-kg for the next four days plus amodiaquine 10 mg-kg day 1-2 and 5 mg-kg on day three in suspension. Adults were given two treatment options: option one four and one-half 50 mg artesunate tablets on day one and nine tablets for the next four days, plus three 500 mg sulphadoxine-25 mg pyrimethamine tablets and option two same artesunate regimen plus nine 200 mg tablets of amodiaquine at 10 mg-kg day 1-2 and 5 mg-kg on day three. The researchers calculated the costs of smears-drugs from standard hospital charges.

ResultsDoctors diagnosed 304 patients 170 adults ages >16 years and 134 pediatric with clinical malaria, prescribing antimalarial drugs to all. Giemsa thick smears were positive in 115-304 38%. The typical patient cost for a Giemsa smear was 550 Naira US$3.74 in 2009. For children, the cost of testing all, but treating only Giemsa positives was N888 $6.04-child; the cost of empiric treatment of all who were clinically diagnosed was lower, N660 $4.49-child. For adults, the cost of testing all, but treating only Giemsa positives was N711 $4.84-adult for treatment option one artesunate and sulphadoxine-pyrimethamine and N730 $4.97-adult for option two artesunate and amodiaquine. This contrasts to lower costs of empiric treatment for both options one N610 = $4.14-adult and two N680=$4.63-adult.

ConclusionsEmpiric treatment of all suspected cases of malaria was cheaper at the end of the dry to the beginning of the rainy season than only treating those who had microscopy-confirmed diagnoses of malaria, even though the majority of patients suspected to have malaria were negative via microscopy. One can acknowledge that giving many malaria-uninfected Nigerians anti-malarial drugs is undesirable for both their personal health and fears of drug resistance with overuse. Therefore, funding of rapid diagnostic tests whose performance exceeds the Giemsa smear is needed to achieve an ideal of diagnostic confirmation before treatment.

Download fulltext PDF



Author: Ravi Parikh - Isaac Amole - Margaret Tarpley - Daniel Gbadero - Mario Davidson - Sten H Vermund

Source: https://link.springer.com/







Related documents