topnaman | Malaria blog

Much of the world still diagnoses malaria clinically (based on symptoms alone without testing for the presence of the parasite). Recently, a Liverpool team working in Mozambique examined the cost to individual patients resulting from the clinical diagnosis of malaria (Malaria Journal - open access). The findings were striking but certainly not surprising. 23 percent of children and 31 percent of adults were overdiagnosed with malaria which resulted in a greater number of healthcare visits and costs for the adult patients.

At a population level, overdiagnosis is expensive for the health system due to the increased wastage of antimalarials and increased demand on provider time. The former concern is more pronounced recently since many countries are now using expensive artemisinin-combination therapies. Increased drug pressure also facilities the emergence and spread of drug-resistant malaria. Drug-resistant malaria increases morbidity and mortality and in some regions of the world our therapeutic alternatives are alarmingly few. I research the epidemiology and mechanisms of antimalarial resistance, and thus the lack of emphasis on parasitogically confirmed treatment is particularly worrisome. A leading malaria researcher once wrote to me, “The problem is even key malaria scientists still have difficulty thinking about how to prevent drug resistance development and how important it is to improve diagnosis and health care infrastructure so that “rational drug use” can be reinforced. They only think about what alternative drugs should be now that this one fails….” Words to heed indeed.