Browsing by Author "Arinaitwe, Emmanuel"

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    Assessment of the accuracy of malaria microscopy in private health facilities in Entebbe Municipality, Uganda: a cross-sectional study
    (BMC Springer Nature, 2021-06-06) Mutabazi, Tobius; Arinaitwe, Emmanuel; Ndyabakira, Alex; Sendaula, Emmanuel; Kakeeto, Alex; Okimat, Paul; Orishaba, Philip; Katongole, Simon Peter; Mpimbaza, Arthur; Byakika‑Kibwika, Pauline; Karamagi, Charles; Nakayaga Kalyango, Joan; Kamya, Moses R.; Dorsey, Grant; Nankabirwa, Joaniter I.
    Although microscopy remains the gold standard for malaria diagnosis, little is known about its accu‑ racy in the private health facilities in Uganda. This study evaluated the accuracy of malaria microscopy, and factors associated with inaccurate smear results at private health facilities in Entebbe Municipality, Uganda. Between April and May 2018, all patients referred for a malaria smear in 16 private health facilities in Entebbe municipality were screened, and 321 patients were enrolled. A questionnaire was administered to collect demographic and clinical information, facility-based smear results were recorded from the participant’s consultation notes, and a research slide was obtained for expert microscopy during exit interview. A health facility assessment was conducted, and information on experience in performing malaria microscopy was collected from all facility personnel reading smears and the data was linked to the participant’s clinic visit. The test positivity rate of malaria parasitaemia was 15.0% by expert microscopy. The sensitivity, specifc‑ ity and negative predictive value of the facility-based microscopy were high (95.8%, 90.1 and 99.2%, respectively). However; the positive predictive value (PPV) was low with 27/73 (63%) patients diagnosed with malaria not having the disease. Majority of the inaccurate results were from 2 of the 23 laboratory personnel reading the smears. The factors associated with inaccurate smear readings included being read by a technician; (1) who had less than 5 years’ experience in reading malaria smears (adjusted Odds Ratio [aOR]=9.74, 95% confdence interval [CI] (1.06–89.5), p-value=0.04), and (2) who was examining less than 5 smears a day (aOR=38.8, 95% CI 9.65–156, p-value<0.001). The accuracy of malaria microscopy in this setting was high, although one third of the patients diag‑ nosed with malaria did not have the disease. Majority of the errors in smear readings were made by two laboratory personnel, with the main factor associated with inaccurate smear results being low experience in malaria microscopy. In-service training may be sufcient to eliminate inaccurate smear results in this setting, and these private facilities would be ideal model facilities to improve the quality of malaria microscopy in Uganda especially in the public sector where accuracy is still poor
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    Do Clinicians in Areas of Declining Malaria Transmission Adhere to Malaria Diagnosis Guidelines? A Cross-Sectional study From Kampala, Uganda
    (BioMed Central Ltd, 2021-04-15) Atukunda, Angella; Mwaka, Amos Deogratius; Arinaitwe, Emmanuel; Orishaba, Philip; Kamya, R. Moses; Nankabirwa, I.Joaniter
    Background: Uganda’s clinical management guidelines recommend a malaria laboratory test in all patients presenting with fever (history of fever or an axillary temperature≥37.5 °C), and only those with a positive test receive anti-malarial treatment. However, the current practice in areas with declining malaria transmission remains unknown. This study assessed the clinicians’ diagnostic practices, the factors associated with recommending a test, and the risk of missing a malaria case when a test is not recommended in patients presenting with fever in Kampala, an area of declining malaria transmission in Uganda. Methods: Between January and March 2020, 383 participants aged≥12 years and presenting to Kisenyi Health Centre IV in Kampala district with fever were enrolled in the study. A questionnaire was administered during exit interviews, routine diagnostic practices were recorded from participant clinical notes, and a research blood slide was obtained for later reading. Results: Of the enrolled participants, 356 (93%) had a malaria diagnostic test recommended by the clinician. Factors associated with increasing prevalence of having a test recommended included; history of overnight travel (adjusted prevalence ratio [aPR] 1.07, 95% confdence interval [CI] 1.02–1.13, p=0.011), being married (aPR=1.07, 95% CI 1.01–1.13, p=0.022), and having tertiary education (aPR=1.09 95% CI 1.01–1.17, p=0.031). Among the 27 participants where a malaria diagnostic test was not recommended, 4 (14.8%) had a positive study smear. Conclusion: Despite having signifcant declines in malaria transmission in Kampala in the last decade, clinicians at the study health facility highly adhered to the clinical management guidelines, recommending a malaria test in almost all patients presenting with fever. However, a signifcant proportion of malaria cases was missed when a test was not recommended. These results highlight the importance of laboratory testing for malaria in all patients who present with fevers and live in endemic settings even when the transmission has signifcantly declined.