In sub-Saharan Africa over 70% of patients with suspected malaria diagnose and manage their illness at home with traditional remedies or drugs bought from local shops. Attendance at a health clinic usually occurs only after home treatment has failed. Primary level health facilities lack tools for detection of malaria parasitaemia so a diagnosis of malaria is usually based on clinical symptoms such as fever. Despite the development of algorithms to improve the specificity of clinical malaria diagnosis,  many infectious diseases mimic malaria illness so this approach leads to over diagnosis rates of 30–70% depending on malaria transmission patterns. Over diagnosis of malaria leads to unnecessary anti-malarial drug use, increased drug resistance, and delays in achieving the correct diagnosis: all of which prompt return visits to health facilities. Background:  It is estimated that over 70% of patients with suspected malaria in sub-Saharan Africa, diagnose and manage their illness at home without referral to a formal health clinic. Of those patients who do attend a formal health clinic, malaria over diagnosis rates are estimated to range between 30–70%. This paper details an observational cohort study documenting the number and cost of repeat consultations as a result of malaria over diagnosis at two health care providers in a rural district of Mozambique. 535 adults and children with a clinical diagnosis of malaria were enrolled and followed over a 21-day period to assess treatment regimen, symptoms, number and cost of repeat visits to health providers in patients misdiagnosed with malaria compared to those with confirmed malaria (determined by positive bloodfilm reading). 

Jen Hume, Guy Barnish et al; 2008, 7:33 doi: 10.1186/1475-2875-7-33