Maternal diagnosis and treatment of children's fever in an endemic malaria zone of Uganda: implications for the malaria control programme.

ABSTRACT

PIP: Maternal ability to suspect malaria in the presence of fever and behavioral changes was investigated in a study of all 439 mothers who had brought febrile children 5 years of age and under to Old Mulago Hospital in Kampala, Uganda, during a 10-day period in the 1992 malaria season. The mothers' diagnosis of malaria was compared with clinical and laboratory diagnoses. Laboratory tests indicated that 64% of these children actually had malaria. Only 40% of mothers suspected malaria in their children. The sensitivity of mothers' diagnosis of malaria was 37%; 63% of malaria cases were misclassified as other conditions. Physicians diagnosed 92% of cases presenting with fever as malaria. The sensitivity of clinical diagnosis was 98%, but the specificity was only 18%. 90% of mothers indiscriminately administered some medication--primarily antimalarials such as chloroquine--before bringing their child to the clinic. In malaria-endemic areas, mothers' inability or delay in relating fever to malaria may have adverse effects on child survival. These findings indicate a need to educate mothers to suspect malaria first when fever is present and to administer appropriate treatment.