1. Challenges Facing the utility of pf specific malaria rapid Diagnostic tests(mrdts)-a case report at Webuye County Hospital-Bungoma County. Challenges Facing the utility of pf specific malaria rapid Diagnostic tests(mrdts)-a case report at Webuye County Hospital-Bungoma County. By Maelo D.N Lab scientist, Rose Nasong’o MLT.

2. INTRODUCTION Malaria remains a public health problem in developing countries of Africa. In Kenya malaria caused by plasmodia species is endemic in western and coastal parts of Kenya and epidemic in Kenyan high altitude areas as highland malaria.Children under 5 yrs and pregnant women are at greater risk of malaria. 15-19% of hospital admission in Kenya are due to Malaria with 3-5% in patient deaths.12% of outpatient clinic visits in Kenya are due to malaria.Each family spends Kshs.1,400 or more annually for treating malaria.170 million working days are lost each year.

3. INTRODUCTION Cont’d Webuye County hospital which is located in Webuye town off Bungoma-Kitale Highway serves As Referral hospital for 26 Health facilities in Bungoma East, other sub-counties in Bungoma county and the better part of kakamega County with an estimated population close to 1.8 million People. The broad objective of the study was to establish challenges faced by usage of pf specific mrdts in malaria diagnosis in Webuye County Hospital.The specific objective is to establish the presence of other plasmodium species other than pf among patients declared malaria negative by pf specific mrdts, ii To determine the percentage positivity per plasmodium species by microscopic examination using Giemsa stain and iii, To determine the Drug of choice for each plasmodium species.

5. METHODOLOGY Examination of Giemsa stained BS from mrdt negative patients using a microscope. Study site-Webuye County hospital Laboratory Study period-Jan to April 2015 Study Design-Case control study Study participant-one Consent-Study participant and close family relatives Inclusion Criteria-Residents from remote areas Exclusion criteria-Residents from Urban Areas Lab diagnosis-Rapid Diagnostic tests, thick and thin blood smears for mps. Clinical Guide-Malaria out patient algorithm

6. Results 20 randomly selected patients were tested by both mrdts and Microscopy and results were compared one patient with critical results was sampled as a case study Patient name was Laban Nakuku, 60 years old, Lab no-20774, From Silungai Location, Manda Sub- location, and Lurare Village with family of 5 children and five Grandchildren who stays in Home bordering Water Points. MRdts-Negative Bs for mps- (10-20 parasites/hpf), species-p.malariae Treatment-Al resistant, responded to @ 2 nd line quinine, artesunate, Chloroquine

7. RAW DATA Lad id noTest1ResultsTest2ResultRemarks 19994mrdtsNegativeMicroscopy1-5 para/100wbcpf 20004`mrdtsnegativeMicroscopy1-4 p/100wbcpm 20014mrdtspositiveMicroscopy10-20p/100wbcPf,pm 20024mrdtsnegativeMicroscopy1-6p/100wbcpo 20044mrdtsnegativeMicroscopy2-7p/100wbcpm 20565mrdtspositiveMicroscopy20-30p/100wbcpf 20575mrdtsnegativeMicroscopy6-10p/wbcpm 20585mrdtsnegativeMicroscopy3-6p/100wbcpm 20603mrdtsnegativeMicroscopy2-4p/100wbcpo 20613mrdtsnegativeMicroscopy4-6p/100wbcpf 20724mrdtspositiveMicroscopy10-15p/100wbcpf 20734mrdtspositiveMicroscopy30-40p/100wbcpf 20744mrdtspostiveMicroscopy20-30p/100wbcpf 20754mrdtsnegativeMicroscopy10-20p/100wbcPf/po 20764mrdtsnegativeMicroscopy5-8 p/100wbc pf 20774mrdtsnegativeMicroscopy10-20p/100wbcP m 20784mrdtsnegativeMicroscopy1-3p/100wbcpm 21017mrdtsnegativeMicroscopy4-10p/100wbcPm/po 21027mrdtspositiveMicroscopy10-20p/100wbcpf

8. KEY: Pm-plasmodium malariae, po-plasmodium ovale, Pf-plasmodium falciparum, PV-plasmodium vivax

9. PERCENTAGE POSITIVITY PER SPECIES MONTH TOTAL TEST DONE TOTAL TEST POSITIVE PLASMODI UM FALCIPAR UM PLASMODI UM OVALE PLASMODI UM MALARIAE PLASMODI UM VIVAX JANUARY % 27321405 1399 99.6% 5 0.36% 1 0.07% 0%0% FEBRUARY % 29401189 1182 99.4% 4 0.34% 3 0.25% 0%0% MARCH % 36551028 1018 99.0% 9 0.87% 1 0.097% 0%0% TOTAL932736223599 99.36% 18 0.497% 5 0.138% 0 0%

10. % POSITIVITY

11. Discussion The above results shows that out of 20 randomly selected samples 14 were negative for mrdts and were all positive for malaria microscopy since mrdts failed to pick malaria parasites from low density samples.The remaining 6 samples were positive in both methods suggesting that mrdts are best in high parasite samples specific for pf species while for different species only microscopy detected the cases.

12. MAP

13. MALARIA OUT PATIENT ALGORITHM

14. Recommended Drugs and Dosages Treatment of uncomplicated malaria First Line Treatment: ◦ Artemether + Lumefantrine (AL)  6 doses given over 3 days ◦ Below 5 Kg Half a tablet of AL under supervision, Dispersible AL is now available and is the most convenient to administer Second Line Treatment ◦ Dihydroartemisinin+Piperaquine (DHAP)  3 doses given over 3 days

15. Recommended Drugs and Dosages In treatment of severe malaria Administer artesunate 2.4 mg/kg body weight at 12 and 24 hours from commencement of the initial dose Then once a day until patient is able to take medication orally(maximum 5 days) Thereafter administer a 3 day course of AL OR oral quinine adults 2 tablets 3 times daily at interval of 8 hours for a period of 3 days

16. Recommended Drugs and Dosages OR iv Quinine administered as a loading dose Of 20 mg/kg quinine in dextrose to run for 4 hours Give 10 mg/kg(max 600mg) 8 hours from commencement of the initial dose of parenteral quinine Repeat 10 mg/kg quinine infusion every 8 hours until the patient can take medication orally

17. REFERENCES 1.WHO.Basic malaria microscopy:Part I and II Learners Guide.Geneva,World Health Organisation 1991 2.WHO,Malaria microscopy Quality assurance manual.Manila,Western pacific Regional office 2009 3.Practical laboratory manual for tropical countries by Monica Cheesbrough 2 nd edition

18. REFERENCES 4.Practical laboratory manual for centers in Eastern Africa by Jane Carter,Organes Lemma 5.Management of severe malaria. A practical handbook second edition. World Health Organisation,Geneva,2000 6.Piola etal, Supervised Vs Unsupervised intake of six dose Artemether Lumefantrine for treatment of acute uncomplicated plasmodium falciparum in Mbarara Uganda:A randomimised trial.Lancet 2005:365-1467-73 7.The British National Formulary 45 th March,2003

19. ACKNOWLEDGEMENT HUQAS scientific committee for review Webuye County Hospital Laboratory staff for their co operation DR Laktabai Moi University Malaria Research Co ordinator, For Availing mrdts For QA/QC SCLC bungoma East,Mr. B Sirrengo for Encouraging and mentorship