Malaria diagnosis: Perspectives from caregivers and health staff, Makarfi, Nigeria

Background: Inappropriate treatment of malaria can result in fatal outcome in children <5years (U5). In 2009, Nigeria reported a mortality of 5 per 100,000. World Health Organisation recommends parasite-based diagnosis for malaria at all ages but presumptive treatment remains common. We conducted a study using mixed methods to determine factors influencing the utilisation of Malaria Laboratory Services (MLS). Methods: We administered structured questionnaires to 296 caregivers of febrile U5 selected consecutively at Makarfi General Hospital (GH), Kaduna state from December 2010 to August 2011. We collected information on factors influencing utilisation of MLS. Focus group discussions (n=4) with purposively selected caregivers at Makarfi community were conducted. Sixteen laboratory staff were interviewed using a semi-structured questionnaire. We analysed quantitative and qualitative data with Epi-info 3.5.3 and thematic approach respectively. Results: Fifteen (5.1%) and 11(4%) caregivers have ever heard about MLS and were ever offered MLS by physicians respectively. Majority believed the need for laboratory diagnosis is mainly influenced by caregiver's perception of illness as severe, request for laboratory diagnosis by physicians, cost and availability of malaria laboratory services. The practice of presumptive treatment and long distance to health facilities were perceived by discussants to deter utilisation of MLS. Lack of basic laboratory reagents, skilled staff and quality assurance mechanism for malaria microscopy and rapid test abound in Makarfi GH. Conclusion: There is low level of awareness, utilisation of and capacity for MLS in Makarfi GH and community. There is a need to increase public awareness, sensitise physicians on and strengthen laboratory capacity for confirmatory malaria diagnosis.