Effect of seasonal malaria chemoprevention in improving health of under five’s in the region of Cascade, Burkina Faso

Abstract

Introduction: Febrile illness is often accompanied by unspecific symptoms , which overlap in viral, bacterial and parasitic infections. Without laboratory diagnostics, these shared symptoms may result in false treatment. Aim: Our goal was to estimate how accurate symptom-based diagnoses were and quantify the false treatment of the most common infectious diseases in rural Ghana. Methods: We analysed data from a hospital study comprising of 1,189 admissions of patients ≤ 15 years to the paediatric ward. Data collected included a symptom-based diagnosis at admission and a set of laboratory diagnostics to identify the cause of disease. Diagnoses were grouped into the most common diseases observed in the study, as well as their indication if treatment would target the underlying pathogen or the symptoms. Assuming the laboratory results revealed the true cause of illness, we compared these findings with the symptom-based diagnosis and calculated sensitivity as well as specificity within each disease group. Results: The most frequent causes of illness were malaria (679, 57%), pneumonia (240, 20%), lower respiratory tract infection (186, 16%), gastrointestinal tract infection (95, 8%), invasive bacterial bloodstream infection (62, 5%) and urinary tract infection (35, 3%). In all of these groups, the suspected diagnosis showed either low sensitivity or speci-ficity (< 80%), or both. A total of 267 diagnoses with an indication for treatment were missed, while in 917 cases the child would have received a treatment it did not need. A further 186 cases were at risk of being over treated, while 29 were at risk of not getting a treatment they needed. Conclusion: Symptom-based diagnosis presented low accuracy and high numbers of over-and under treatment, emphasizing the necessity of laboratory diagnostics for the correct differentiation of febrile illness in rural Ghana.