Abstract:

Background: Fever has been the main reason for hospital consultation by children under five years old. In Tanzania, malaria was contributing to about 42% of hospital diagnoses and 32% of hospital deaths to children in the last decade. However, many malaria intervention programs have led to the decline of malaria, therefore about 65% of the fevers that were once thought to be due to malaria are now due to non-malarial causes. Thorough investigation of the actual of fever should be a priority before prescription of any drug.

Methods: An observational cross-sectional study was carried out in two health centers in Arusha district. Children under the age of five years with fever or a history of fever were recruited and the medical examination, diagnostic tests performed and drugs given were observed to assess proportion of febrile children who are still prescribed antimalarial drugs despite having negative mRDT results. Factors influencing antimalarial drug prescription to children with non-malarial fever was obtained through observation and interviews with health workers responsible.

Results: Out of 200 participants who presented with fever and other symptoms, only 7(3.5%) were tested for malaria using malaria rapid diagnostic test (mRDT). 6(85.7%) had a positive mRDT result and 1(14.3%) had negative mRDT result. All the mRDT positive patients were prescribed ACTs, 2(33.3%) receiving ACTs with antibiotics, the remaining 4(66.7%) received ACTs and Paracetamol. The mRDT negative patient 1(14.3%) also received an ACT, antibiotic and Paracetamol.

Conclusion: Health workers failed to acknowledge fever as a potential symptom for malaria. Prescription of antimalarial drug to a patient with negative mRDT results was associated with limited knowledge of mRDT. There is poor management of febrile children, associated with diagnosing without relying on diagnostic tests and over prescription of antibiotics due to failure of differentiating viral infections from bacterial infections.