The use of the laboratory in the management of malaria at Kenyatta National Hospital (K.N.H)

Abstract

In this study 165 malaria case files of 1988 were studied and 78 patients of the patients admitted with a diagnosis of malaria between November 1989 and March 1990 were studied to find the usage of the laboratory in the magement of malaria patients. In the 1988 case file review, 41.8% of the patients were treated without microscopic demonstration of malaria parasites. 15.8\ had no blood slides done and 26%had blood slides which were reported as negative for malaria parasites. Choice of antimalarial drugs is influenced by the clinical state of the patient and the density of the malaria parasites, with a higher proportion of patients with heavy parasitaemias being given quinine. Change of antimalarial therapy is also mainly determined by clinical improvement (in 40 %of the patients who had their treatment changed) and persistance of malaria parasites (11.4%) During follow up and discharge of the patient, clinical improvement is a more important factor with 57.6% being discharged without blood films being done, 7.9% of the patients were discharged while they still had positive blood slides. The standard of reporting was assessed by reviewing all the 240 laboratory reports which were found in the 165 malaria case files of 1988 where 60.5% of all the ones reported a positive had incomplete, with 39.5/%having complete reports . - 2 - 175 stained and reported blood slides were obtained from the routine laboratory and assessed for preparation and reporting 54.3% were of satisfactory thickness, 33.1\ were found to be too thick and 12.6% were too thin. The level of agreement was higher in the well prepared ones (satisfactory thickness) than the other preparations. The overall agreement taking irito account the estimation of the density of malaria parasites was 63.4%. If only presence or absence of malaria parasites, then the agreement was 82.9%. 33 of the 78 patients in the prospective study produced

urine. In 81.8% it was positive for the Dill Glazko test. Clearance of malaria parasites is higher in adults than in children. Children have a higher in vivQ resistance rate with 43.8% exhibiting RII level of resistance compared to 16.7% in adults. There was failure of growth and maturation to Schizonts in all the wells in the in vitro studies, this was thought to be due to previous administration of antimalarial drugs.