What happens when the test is negative: Evaluating adherence to malaria diagnostic algorithms among under-five children in the Northern zone of Volta Region, Ghana

Abstract

Background: In Ghana, the Ministry of Health (MOH-GH) have recommended that every suspected malaria case is tested and treatment given should be based on test results. However, several patients are still given antimalarial drugs without confirmation of malaria. The objective of this study was to determine the proportion of under-five children who received diagnosis of malaria from clinicians even when the test was negative for malaria.

Methods: A cross-sectional study was used which involved two randomly selected government-owned hospitals in the Northern zone of Volta region in Ghana. For each hospital, 439 under-five children participated in the study. Adherence to the malaria test results was based on the mRDT and expert microscopy test results in the selected hospitals.

Results: Of 878 eligible children screened, 615 (70.1%) tested negative for malaria. Out of the negative test results, 299 (48.6%) were with RDT and 316 (51.4%) with microcopy. 25 (8.4%) and 67 (21.2%) of the RDT and microscopy negative test results were still diagnosed with malaria and treated with antimalarial drugs respectively.

Conclusion and recommendation: Despite the institution of the guidelines for malaria case management, some clinicians still prescribe antimalarial drugs to children under five years with negative test results. There is need for enhanced training for health workers on adherence to malaria test results.