ABSTRACT
Clinical audit was performed on the accuracy of malaria diagnosis by nursing staff within Harare City Health Department using diagnosis by doctors as the reference standard. This was found to be about 10 pc based on symptoms. The criteria for diagnosis of malaria as in ZEDAP manuals and in-house training were not being utilised. Pyrexia was not present in 40 pc of the patients. Serious illnesses were occasionally dismissed as malaria and not treated appropriately or reviewed. The most common misdiagnosis was of acute respiratory tract infections which also have clear guidelines for diagnosis. More appropriate training methods need to be developed to improve the diagnostic capacity of nursing staff who are frontline providers of primary health care. This study shows the importance of performing an audit for process evaluation, compared to set standards and to be used for improving the quality of services.
PIP: Malaria remains a serious public health problem in many areas of Zimbabwe, especially during the wet season from February to May. Findings are reported from a clinical audit conducted between July 1989 and January 1990 on the accuracy of malaria diagnosis by nursing staff in the Harare City Health Department using diagnosis by six clinic doctors as the reference standard. The study was scheduled for the dry season to minimize the number of malaria cases presenting, with questionnaires completed on 92 subjects from 11 clinics. The investigation found approximately 10% of the diagnoses to be based upon symptoms, the criteria for diagnosing malaria as outlined in Zimbabwe Essential Drugs Action Program manuals and in-house training were not being followed, pyrexia was not present in 40% of patients, serious illnesses were occasionally dismissed as malaria and not treated appropriately or reviewed, and the most common misdiagnosis was of acute respiratory tract infections which also have clear guidelines for diagnosis. Better training methods need to be developed to improve the diagnostic capacity of nursing staff, the frontline providers of primary health care.
