Urban malaria in the Sahel: Prevalence and seasonality of presumptive malaria and parasitaemia at primary care level in Chad

OBJECTIVE: To assess malaria prevalence rates and seasonal patterns among clinically diagnosed malaria cases at the level of primary care facilities in an urban Sahelian setting. Screening all patients consulting two private and two governmental providers on a randomly selected weekday over a period of 9 months. Patients with presumptive malaria underwent a blood test. RESULTS: Of 1658 patients included in the survey, 47% were clinically diagnosed and treated as malaria cases. Malaria was more often diagnosed by private providers. There were no clear seasonal patterns in presumptive malaria. A 30% of clinically diagnosed cases were positive for Plasmodium (all falciparum) by thick film examination. Thus, false positive cases constituted more than 70% of the clinically diagnosed malaria cases. The highest positive prevalence rates were found at the end and shortly after the rainy season (44%-47%) and the lowest during the dry season (2%). CONCLUSIONS: Clinical diagnosis of malaria has a very low positive predicted value in this low endemicity urban setting, and its low specificity leads to inappropriate care for a large proportion of patients. This has a major impact on economic costs for health services and households. In the Sahel, systematic use of microscopy-based diagnosis and/or rapid diagnostic tests should be considered to appropriately manage malaria and non-malaria cases. © 2006 Blackwell Publishing Ltd.