Clinical diagnosis of malaria : can we improve?

Most cases of malaria in Zimbabwe are diagnosed on the basis of clinical suspicion; without laboratory tests. Of patience treated; between 10 and 30 have malaria parasites on blood slide examination. Can diagnosis be improved by a systematic history? We examined this question in 287 patients treated for malaria in an area of year-round transmission in Zimbabwe. The most common complaints were 'headache' (85.7); 'bodily weakness' (79.0) and 'fever/feeling hot' (73.2). Eighty patients (28) had malaria parasites on blood smear. Using the blood slide as the standard; we calculated the sensitivity; specificity and positive predictive value of a variety of clinical symptoms and signs. None had a positive predictive value substantially higher than the unknown diagnostic criteria used by health workers (28). Multi-variate analysis showed that 15 different demographic and clinical variables did not significantly predict a positive blood slide result. We conclude that; in this setting; clinical history alone will not improve the diagnosis of malaria

Relationship between bladder cancer incidence; schistosoma haematobium infection; and geographical region in Zimbabwe

Bladder cancer is common in Zimbabwe; possibly due to the high prevalence of Schistosoma haematobium infection in some areas. We undertook a correlational study based on retrospective medical record review to see whether the number of bladder cancers could be related to geographical region and prevalence of S. haematobium infection. We also determined patient demographic characteristics and tumour histology. Of 483 patients indentified (1984-1987); 69 with available histology had squamous cell carcinomas. The remainder had transitional cell carcinomas. Patients with squamous cell carcinoma were younger than patients with transitional cell carcinomas (50 vs 20 under 50 years old; P less than 0.05) and had a sex ration of one. [abstract terminated]

Community based schistosomiasis control in Zimbabwe

The project was established to investigate the feasibility of a national schistosomiasis control programme in Zimbabwe based upon an intergrated approach. The project involved community self help sanitation and water programmes; health education; chemotherapy of school children with praziquantel; and focal mollusciciding. The project was carried out in two rural areas of Zimbabwe with a combined population of over 40;000 people. Madziwa (32;00 people) had all of the above interventions; and Bushu (8.000 people) had only the chemotherapy intervention. Infection with schistosomiasis was determined by the use of reagent strip examination for haematuria. This low cost method of diagnosis was found to be very appropriate and feasible for the examination of large numbers of children and the method was recommended for use in a national control programme. Pretreatment infection levels with schistosomiasis generally exceeded 60in both areas although there was considerable heterogenity in distribution