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 .
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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.
Citation
Degree of Master of Medicine (Pathology) of the University of NairobiPublisher
School of Medicine
Description
A dissertation presented in part fulfilment
for the Degree of Master of Medicine (Pathology)
of the University of Nairobi