Investigation of malaria by microscopy among febrile outpatients of a semi-rural nigerian medical center: What happened to malaria control programs?
Godpower Chinedu Michael1, Ibrahim Aliyu2, Umma Idris3, Haliru Ibrahim4, Obadire Samuel Olalere5, Bukar Alhaji Grema1, Monsur Ajibola Shittu6, Sunday Abah6
1 Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
2 Department of Paediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Paediatrics, Federal Medical Centre, Birnin Kudu, Jigawa, Nigeria
4 Department of Medicine, Federal Medical Centre, Birnin Kudu, Jigawa, Nigeria
5 Department of Medical Laboratory, Federal Medical Centre, Birnin Kudu, Jigawa, Nigeria
6 Department of Family Medicine, Federal Medical Centre, Birnin Kudu, Jigawa, Nigeria
Godpower Chinedu Michael
Department of Family Medicine, Aminu Kano Teaching Hospital, P.M.B. 3452 Kano
Source of Support: None, Conflict of Interest: None
Background: Older reports estimate that malaria accounts for 60% of outpatient clinic encounters in Nigeria. However, current estimates suggest that malaria control programs have considerably reduced malaria-related morbidity and mortality on a global scale. The extent to which these programs impacted malaria prevalence in endemic countries such as Nigeria after the Millennium-Development Goals era may not have been fully appreciated. This study, therefore, assessed how common malaria was among febrile patients attending a semi-rural medical center in Nigeria. Materials and Methods: This was a cross-sectional study involving 290 randomly selected general and pediatric outpatients (who fulfilled inclusion criteria) attending the Federal Medical Centre, Birnin Kudu in August 2016. It assessed participants' clinical features, insecticide-treated net usage and presence of malaria parasitemia (confirmed by microscopy). Results: Participants' overall mean age was 18.4 ± 16.3 years (ranging from 0.25–62.0 years); 146 (50.3%) were females; 73.4% used insecticide-treated-net the previous night. Their mean overall temperature was 37.7°C ± 1.1°C. Overall malaria prevalence was 65.5%; however, the incidence was highest in ≥15 years age-group (30.3%) followed by ≤4 years age group (20.7%). Clinical features predicting malaria parasitemia were pallor (odds ratio [OR] = 5.03, 95% confidence interval [CI] = 1.96–14.42) and history of convulsion (OR = 4.06, 95% CI = 1.53–10.78). Their median parasite density was 1 ± 1.3. Clinical features poorly predicted malaria parasite density among participants. Conclusion: The malaria prevalence in this study was worryingly high. There is a need to review or modify current malaria control programs using more comprehensive strategies if reduction in the malaria-related morbidity and mortality in this and similar settings is desired.