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ABSTRACT
In Nigeria, malaria accounts for 30% mortality in children <5years (U5). World Health
Organisation guidelines recommend parasite-based diagnosis prior to commencement of
antimalarial treatment. However, empirical treatment remains a common phenomenon at homes
and in clinical settings because of presumed high malaria prevalence. This is compounded by
inadequate information on accuracy of malaria rapid diagnostic test (RDT). Data on factors
affecting the utilisation of malaria laboratory services (MLS) is not readily available. We
conducted a study to assess the diagnostic accuracy of Standard Diagnostic (SD) Bioline malaria
rapid diagnostic test, and to determine the factors affecting the utilisation of MLS in febrile
children in Kaduna State, Northern Nigeria.
We conducted a cross-sectional study of 296 caregivers of febrile U5 at Makarfi General
Hospital (MGH), Kaduna state from December 2010 to August 2011. We used structured
questionnaires to collect data on socio-demographics of caregivers, clinical information on
febrile U5, and utilisation of MLS. Blood samples were collected from 296 U5 and examined for
malaria parasites with SD Bioline rapid diagnostic test (RDT) and routine microscopy. The
diagnostic accuracy of the RDT was determined. Focus group discussions (n=4) were conducted
at Makarfi communities to determine the factors affecting utilisation of MLS among caregivers
of children U5. Eight key informants were interviewed to determine the capacity for malaria
diagnosis at MGH.
VI
The sensitivity, specificity, negative and positive predictive values of SD Bioline RDT were
100%, 98.5%, 100% and 88.6% respectively. The prevalence of malaria in the febrile children
was 10.5% and 11.8% by RDT and microscopy respectively. Plasmodium falciparum infection
rate was 100%. Overall, 3.7% of caregivers were offered any malaria laboratory test by health
staff and 5.5% have ever heard about MLS. Non-request of MLS by health staff, lack of
awareness, presumptive treatment, and long distance from health centre, caregiver’s perceived
severity of illness, high cost, and non-availability of MLS were responsible f
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