RESUMO
BACKGROUND: Malaria is one of the most common causes of mortality worldwide. The World Health Organization (WHO) has recently recommended that treatment should be guided by a laboratory diagnosis. The aim of this study is to explore patient and health care factors associated with intravenous antimalarial treatment of malaria test-negative patients at a district hospital in a malaria endemic area. STUDY DESIGN: A cross-sectional study of 91 patients admitted for intravenous antimalarial treatment was done at a district hospital in northern Cameroon in July and August 2010. Socio-cultural and clinical factors were studied in relation to quality blood smear results. RESULTS: Thirty-two per cent of all intravenous antimalarials were administered to patients with a negative malaria test. Test negative patients older than 40 years of age received significantly more often intravenous antimalarials than the youngest patients (OR = 7.9, 95% CI = 1.9-32.4, p = 0.004). Few differential diagnoses were identified in the study population, and patients older than 30 years of age had malaria less often than the youngest patients (OR = 0.3, 95% CI = 0.08-0.9 and OR = 0.09, 95% CI = 0.02-0.4). CONCLUSION: This study supports previous reports of over-diagnosis and treatment of malaria in endemic areas. The results suggest that differential diagnoses are important, especially in adults with febrile illnesses to ensure the correct diagnosis and treatment. Further studies are needed to explore the findings and to develop strategies to improve the management of malaria and its differential diagnoses.