Global malaria diagnostic and treatment guidelines recommend that every suspected malaria case be tested, every confirmed case be treated, and the disease tracked by surveillance systems. The process of diagnosis is initiated by a suspicion of malaria on the basis of a defined set of clinical criteria, with the most notable symptom being fever. For optimal treatment, an accurate diagnosis is therefore essential. While there is clear guidance for the diagnosis for non-severe suspected malaria cases, providers at health facilities do not always follow these recommended steps. This report investigates the quality of diagnostic services for non-severe suspected malaria cases, using the observation of sick child consultations and the exit interview of caretakers from the 2013-14 Malawi Service Provision Assessment (SPA) and the 2014-15 Tanzania SPA, which are nationally representative health facility surveys.
We identified essential clinical care elements that should be performed for all non-severe suspected malaria cases that are also available in the SPA surveys. These included: 1) provider asked about fever; 2) child was felt for temperature, had temperature taken with a thermometer, or checked for pallor by looking at palms; and 3) provider instructed child to see another provider or laboratory for a finger or heel stick for blood testing. Among non-severe suspected malaria cases, 34% in Malawi and 25% in Tanzania received all three elements of diagnostic clinical care. We assessed the client/visit-, provider-, and facility-level factors that might explain variations in the quality of diagnostic services of non-severe suspected malaria cases, using multilevel random-effects logistic regressions, for Malawi and Tanzania separately. In both Malawi and Tanzania, the age of child, malaria endemicity/seasonality, and facilities having adequate supplies for diagnostic testing were significant factors for children receiving all three elements of quality of care. In both countries, these findings show the importance of malaria service readiness for providing high quality of care for febrile children. Having facilities with diagnostic capabilities will help ensure that providers adhere to malaria diagnostic guidelines.