Malaria rapid diagnostic test positivity rate among febrile patients seen at the Paediatric emergency unit of a tertiary care facility

Abstract

Background: Malaria, a life-threatening parasitic disease transmitted to humans by the female Anopheles mosquito is one of the infectious causes of fever in children. In Nigeria, malaria remains one of the most important health problems, accounting for 25% of infants and 30% of under-five mortalities. The objective of this study was to determine the prevalence of malaria among febrile children presenting at the children's emergency room (CHER) of a tertiary health facility in Abakaliki using a malaria rapid diagnostic test (mRDT).

Methodology: This was a retrospective study that involved children presenting with fever in CHER over a 3-year period. A total of 1,273 febrile children below 18 years of age were tested with a malaria rapid diagnostic test (mRDT) kit during this period. Medical records of the patients were assessed to retrieve information such as age, gender, and clinical diagnoses. Data were analyzed using SPSS version 25.

Results: A total of 707 (55.5%) were males and 883 (69.4%) were below 5 years of age. The overall prevalence of malaria by the mRDT test was 26% (n=331). Uncomplicated malaria, 283 (22.2%) was the commonest clinical diagnosis made while the least was malnutrition 3 (0.2%). Children aged 10-<18 years were predominantly affected as mRDT positivity rate was significantly higher in children age group 10-<18 years (40.4% 76/189) than other age groups (X²=44.76, p<0.001). Similarly, the rate was significantly higher (OR 9.625, 95% CI 7.233-12.808, p<0.0001) in children with the clinical diagnosis of malaria (55.2%, 235/426) than those with the clinical diagnosis of other illnesses (11.3%, 96/847), and significantly higher (OR 0.19, 95% CI 0.1186-0.3043, p<0.0001) among those clinically diagnosed with complicated (79.7%, 114/143) than those with uncomplicated malaria (42.8%, 121/283).

Conclusion: There is a high prevalence of malaria among febrile children presenting at the CHER of Alex Ekwueme Federal University Teaching Hospital Abakaliki. Children age group 10-<18 years were predominantly affected. The use of mRDT should be encouraged both as a screening and diagnostic tool with a protocol such that febrile children who have positive results are confirmed as having malaria while those with negative results are further evaluated with microscopy.