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Influences and mindlines for malaria over-diagnosis |
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| Sphere of influence |
Motives for malaria diagnosis |
Motives for not treating alternative diagnoses |
Motives for treating alternative diagnoses |
Mindlines |
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| Patient outcome |
Patient likely to be cured if malaria parasites present |
Patient likely to be cured if no malaria parasites present at low endemicity, or even if parasitaemic at high endemicity (co-morbidity) |
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| Diagnostic support |
Easy and quick to diagnose and treat |
More complicated diagnosis and treatment |
Malaria is easier to diagnose than alternatives |
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| Perceived as easily recognisable |
Alternative diseases perceived as less specific |
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| Fewer tests needed for confirmation |
Increased number and complexity of tests (e.g. lumbar puncture) |
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| Feel confident to diagnose clinically |
Clinical diagnosis less clear, may need to wait for test results |
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| Laboratory test results may be incorrect (due to resource problems, staff skills) or the parasites may be hidden |
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| Well established process of malaria diagnosis and treatment |
No set process: if time short or motivation low may be easier to take established path |
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| No retribution for over-diagnosing malaria |
Lack of supervision or regular advice to consider differential diagnoses |
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| Disease promotion and training |
Well known disease with frequent training available |
Less well known diseases, less training available |
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| Guidelines are malaria specific |
Few guidelines for alternative diseases |
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| Patient preferences |
Perceived as preferable to patients |
Fear of patient complaints if don't test or treat for malaria |
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| Perceived as acceptable to patients: high profile, low-stigma disease |
More explanation necessary for patients who may prefer the familiarity of malaria |
Malaria is a more acceptable diagnosis |
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| Peer pressure |
Perceived as acceptable to peers who also see over-diagnosis as preferable to missing malaria |
Alternative diagnoses may require clinicians to justify themselves |
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| Disease promotion and training |
Malaria promoted by public health campaigns as most important disease |
Alternative diseases less often promoted resulting in lower profile |
Missing malaria is indefensible |
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| Training emphasises malaria over alternative diseases |
Alternative diseases taught in theory more than practice |
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| Indefensible to miss malaria, perceived as most important disease |
More defensible to miss alternative causes of disease |
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Chandler et al. Malaria Journal 2008 7:53 doi:10.1186/1475-2875-7-53 |
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