Diagnosis and treatment of malaria

Malaria is a major public health problem and is endemic in about 107 countries. The symptoms of uncomplicated malaria are non-specific and similar to many other disease syndromes, including minor viral illnesses. People living in areas where malaria is endemic are often familiar with these symptoms and frequently diagnose themselves, so that over-diagnosis is widespread.1

Prompt and accurate diagnosis of malaria is important for effective case management and if implemented well should reduce mortality from this disease.2 High sensitivity of diagnosis is crucial, and high specificity could reduce unnecessary treatment and improve the diagnosis of other febrile illness.3 In this week's BMJ, a randomised controlled trial by Reyburn et al assesses the effect of rapid diagnostic tests compared with microscopy for guiding treatment of acute febrile illness in outpatients in Tanzania.4

Light microscopy and rapid diagnostic tests are the two most commonly used methods of confirming a diagnosis of malaria. Microscopy, the gold standard, has several advantages including low cost and high sensitivity and specificity when used by well trained staff. Rapid diagnostic tests (which detect parasite antigens) are easier …