1. TITLE
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 % 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.
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.

4. 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

5. 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 2nd line quinine, artesunate, Chloroquine

6. RAW DATA Lad id no Test1 Results Test2 Result Remarks 19994 mrdts
Negative
Microscopy
1-5 para/100wbc pf
20004`
negative
1-4 p/100wbc pm
20014
positive
10-20p/100wbc
Pf,pm
20024
1-6p/100wbc po
20044
2-7p/100wbc
20565
20-30p/100wbc
20575
6-10p/wbc
20585
3-6p/100wbc
20603
2-4p/100wbc
20613
4-6p/100wbc
20724
10-15p/100wbc
20734
30-40p/100wbc
20744
postive
20754
Pf/po
20764
5-8 p/100wbc
20774
P m
20784
1-3p/100wbc
21017
4-10p/100wbc
Pm/po
21027

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

8. PERCENTAGE POSITIVITY PER SPECIES
MONTH
TOTAL TEST DONE
TOTAL TEST POSITIVE
PLASMODIUM FALCIPARUM
PLASMODIUM OVALE
PLASMODIUM MALARIAE
PLASMODIUM VIVAX
JANUARY %
2732
1405
1399
99.6% 5
0.36% 1
0.07%
FEBRUARY
2940
1189
1182
99.4% 4
0.34% 3
0.25%
MARCH
3655
1028
1018
99.0% 9
0.87%
0.097%
TOTAL
9327
3622
3599
99.36% 18
0.497%
0.138% 0%

9. % POSITIVITY

10. 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.

11. MAP

12. MALARIA OUT PATIENT ALGORITHM

13. 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

14. 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

15. 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

16. 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 2nd edition

17. 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:
7.The British National Formulary 45 th March,2003

18. 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