Malaria Microscopy Performance in Self-presenting Febrile Patients at Four Health Facilities in Fen Tale District of East Shewa, Ethiopia

Abstract

Correct and reliable microscopic examination results are vital in appropriate treatment of malaria in endemic areas, mainly where Plasmodiumn falciparum and P. vivax co-exist in Ethiopia. Thus, evaluation of regular malaria microscopy performance is needed. To evaluate the performance of regular malaria microscopy and antimalarial drug prescription practices for self presenting febrile patients at health facilities located in malaria endemic areas of upper Awash Valley, eastern central Ethiopia. A cross sectional study design was used to recruit 260 febrile patients at four health facilities in Fentale district. All slides collected at health facilities were rechecked in reference laboratories and Kappa score was calculated to see the slide reading agreement. Malaria parasites from clinical cases were found in 19.6% (51/260) of the total febrile patients of which 82.4% (42/51) were infected with P. vivax and 17.6% (9/51) with P. falciparum. Overall sensitivity, specificity, positive and negative predictive values of regular malaria microscopy readings were 92.2%, 83.7%, 58% and 97.8%, respectively. Artemether-lumefantrine over prescription rates was 50.8% by the regular microscopy and 53.6% by reference microscopy. There was only a moderate agreement between regular malaria microscopy and reference microscopy with the Kappa value of 0.52. The overall reading agreement and agreement on species identification of the regular and reference microscopy were low. There was variability in performance in the different health facilities. Sensitivity, specificity, and positive predictive value of regular malaria microscopy need to be improved for accurate diagnosis and prompt treatment of malaria cases in Fentale district health facilities. There should be rational use of antimalarials especially on slide negative subjects.