felled by fever

As my partner-in-crime was felled by a fever this weekend, I got to wondering how often people treat themselves for malaria when they really have a nasty virus, flu or otherwise. If you don’t have the time, resources, or energy, it might seem like a good idea to pop some anti-malarials (assuming you can get them) just in case.

I gave a presentation about health services and malaria in Uganda several weeks ago, in which, among other things, I bemoaned the lack of attention malaria receives from government. Browsing various publications, studies, and policy reports, I mentioned several stats, including the following:

• Malaria is the cause of 32% of child deaths in Uganda (DHS Child Verbal Autopsy 2007)
• 42% of children tested positive for malaria during the DHS Malaria Indicator Survey 2009 , compared to 0.7% in Ethiopia, 2.6% in Rwanda, 7.6% in Kenya, and 18% in Tanzania.
• Malaria is responsible for 30-50% of all outpatient visits, 15-20% of all admissions, and 9-14% of all inpatient deaths
• Uganda ranks third in the world in terms of malaria deaths

One of the audience members asked about the accuracy of reporting of malaria cases in Uganda. While malaria is undeniably one of the most important health challenges Uganda faces, it is important to acknowledge that the capacity to diagnose malaria is generally weak, and many if not most of the malaria cases and deaths are not laboratory confirmed. There is probably a sizable chunk of these “malaria cases” that are not actually malaria, but rather a flu or some other virus or infection.

The 2009 Malaria Indicator Survey found that of the 3,727 children included in the survey, 44.7% were reported to have had a fever in the preceding two weeks. While 70% of children with fever were taken to a health facility or health provider, only 17% were reported as having been tested for malaria through a finger or heel prick. 60% of children with fever ended up taking anti-malarials, and 15% took antibiotics.

I’m still astounded that 42% of the children in the survey tested positive for malaria (62% were anemic). This figure is especially high when you compare it with other countries in the East African region (see above). Prevalence varies quite a bit by region as well.

Source: Uganda Malaria Indicator Survey 2009, page 61.

The internet has slowed to a crawl, but I’ll post some more links on this soon.