Title : An audit into the time taken between presentation and diagnosis of malaria and adherence to malaria treatment guidelines at Southend University Hospital‚ UK
Abstract:
Malaria is a life-threatening illness, caused by infection of red blood cells by Plasmodium parasites. It is transmitted through the bite of infected female Anopheles mosquitoes. Symptoms tend to be non-specific, such as fever and malaise, which can make it difficult to detect. Complications can be fatal, and can include coagulopathy, hypoglycaemia, severe anaemia and splenic rupture. Diagnosis is done through rapids tests and examination of thick and thin blood smears by microscopy. Treatment is dependent on whether the malaria species is falciparum or non-falciparum.
In the UK, the approach to malaria is informed by the ‘UK malaria treatment guidelines 2016’ published by the BIA. In 2023, 2,106 cases of malaria were reported in the UK.
The aim of this project was to reduce the interval between presentation and diagnosis of malaria, and to improve adherence to malaria treatment guidelines at Southend University Hospital, a district general hospital in UK.
The standards were set that 90% of cases should be diagnosed within 6 hours of presentation, and 100% of patients should receive the appropriate treatment for their malaria type (non-falciparum, falciparum complicated and falciparum uncomplicated).
All malaria testing requests made between 1/10/2018 to 30/9/2023 were reviewed. 9 positive cases of malaria were identified. Electronic patient records were reviewed, and the following information was retrieved: time presented to ED, time malaria test was requested, time results came back, malaria type, what treatments were started and if specialist advice was sought.
Data analysis showed that 67% of malaria cases were diagnosed within 4 hours of presentation, 78% of malaria cases were diagnosed within 6 hours of presentation and 22% of malaria cases took 10+ hours to diagnose. In terms of treatment, 7/9 cases (78%) received the correct treatment for their malaria type.
The sample size for this project was extremely small, however, there were crucial learning points. Risk factors for delayed diagnosis included no travel history gained, poor interpretation of travel history, alternative diagnosis suspected, difficulty interpreting results, and not clarifying if prophylaxis was taken and completed.
Moving forward, making guidelines more easily available to all emergency staff, knowing what team to seek advice from, incorporating malaria into medical education curriculums, and involving a range of specialties such as pharmacy and lab colleagues in discussions may help to improve detection and treatment of malaria. Due to the very few cases seen, this project can only be re-audited after a few years.
