{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T13:42:20Z","timestamp":1784036540836,"version":"3.55.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,15]],"date-time":"2021-04-15T00:00:00Z","timestamp":1618444800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,4,15]],"date-time":"2021-04-15T00:00:00Z","timestamp":1618444800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["D43TW010526"],"award-info":[{"award-number":["D43TW010526"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Emerging global leader awards NIH","award":["K43TW010365"],"award-info":[{"award-number":["K43TW010365"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Malar J"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Uganda's clinical management guidelines recommend a malaria laboratory test in all patients presenting with fever (history of fever or an axillary temperature\u2009\u2265\u200937.5\u00a0\u00b0C), and only those with a positive test receive anti-malarial treatment. However, the current practice in areas with declining malaria transmission remains unknown. This study assessed the clinicians\u2019 diagnostic practices, the factors associated with recommending a test, and the risk of missing a malaria case when a test is not recommended in patients presenting with fever in Kampala, an area of declining malaria transmission in Uganda.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between January and March 2020, 383 participants aged\u2009\u2265\u200912\u00a0years and presenting to Kisenyi Health Centre IV in Kampala district with fever were enrolled in the study. A questionnaire was administered during exit interviews, routine diagnostic practices were recorded from participant clinical notes, and a research blood slide was obtained for later reading.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the enrolled participants, 356 (93%) had a malaria diagnostic test recommended by the clinician. Factors associated with increasing prevalence of having a test recommended included; history of overnight travel (adjusted prevalence ratio [aPR] 1.07, 95% confidence interval [CI] 1.02\u20131.13,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011), being married (aPR\u2009=\u20091.07, 95% CI 1.01\u20131.13,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.022), and having tertiary education (aPR\u2009=\u20091.09 95% CI 1.01\u20131.17,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.031). Among the 27 participants where a malaria diagnostic test was not recommended, 4 (14.8%) had a positive study smear.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite having significant declines in malaria transmission in Kampala in the last decade, clinicians at the study health facility highly adhered to the clinical management guidelines, recommending a malaria test in almost all patients presenting with fever. However, a significant proportion of malaria cases was missed when a test was not recommended. These results highlight the importance of laboratory testing for malaria in all patients who present with fevers and live in endemic settings even when the transmission has significantly declined.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12936-021-03729-8","type":"journal-article","created":{"date-parts":[[2021,4,15]],"date-time":"2021-04-15T10:48:47Z","timestamp":1618483727000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Do clinicians in areas of declining malaria transmission adhere to malaria diagnosis guidelines? A cross-sectional study from Kampala, Uganda"],"prefix":"10.1186","volume":"20","author":[{"given":"Angella","family":"Atukunda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mwaka Amos","family":"Deogratius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Arinaitwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Orishaba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses R.","family":"Kamya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaniter I.","family":"Nankabirwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,15]]},"reference":[{"key":"3729_CR1","volume-title":"Uganda National Malaria Control Guidelines","author":"Ministry of Health","year":"2015","unstructured":"Ministry of Health. Uganda National Malaria Control Guidelines. Kampala: Ministry of Health; 2015."},{"key":"3729_CR2","volume-title":"Malaria indicator survey 2018\u20132019","author":"National Malaria Control Programme Uganda Bureau of Statistics","year":"2018","unstructured":"National Malaria Control Programme Uganda Bureau of Statistics. Malaria indicator survey 2018\u20132019. Kampala: National Malaria Control Programme, Uganda Bureau of Statistics; 2018."},{"key":"3729_CR3","doi-asserted-by":"publisher","first-page":"903","DOI":"10.4269\/ajtmh.14-0312","volume":"92","author":"MR Kamya","year":"2015","unstructured":"Kamya MR, Arinaitwe E, Wanzira H, Katureebe A, Barusya C, Kigozi SP, et al. Malaria transmission, infection, and disease at three sites with varied transmission intensity in Uganda: Implications for malaria control. Am J Trop Med Hyg. 2015;92:903\u201312.","journal-title":"Am J Trop Med Hyg"},{"key":"3729_CR4","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1186\/1475-2875-13-111","volume":"13","author":"M Kilama","year":"2014","unstructured":"Kilama M, Smith DL, Hutchinson R, Kigozi R, Yeka A, Lavoy G, et al. Estimating the annual entomological inoculation rate for Plasmodium falciparum transmitted by Anopheles gambiae s.l. using three sampling methods in three sites in Uganda. Malar J. 2014;13:111.","journal-title":"Malar J."},{"key":"3729_CR5","doi-asserted-by":"publisher","first-page":"219","DOI":"10.4269\/ajtmh.2006.75.219","volume":"75","author":"PE Okello","year":"2006","unstructured":"Okello PE, Van Bortel W, Byaruhanga AM, Correwyn A, Roelants P, Talisuna A, et al. Variation in malaria transmission intensity in seven sites throughout Uganda. Am J Trop Med Hyg. 2006;75:219\u201325.","journal-title":"Am J Trop Med Hyg"},{"key":"3729_CR6","volume-title":"Uganda malaria indicator survey 2009","author":"National Malaria Control Programme Uganda Ministry of Health","year":"2010","unstructured":"National Malaria Control Programme Uganda Ministry of Health. Uganda malaria indicator survey 2009. Kampala: National Malaria Control Programme, Uganda Ministry of Health; 2010."},{"key":"3729_CR7","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1186\/s12936-018-2577-x","volume":"17","author":"H Kaula","year":"2018","unstructured":"Kaula H, Kiconco S, Nu\u00f1ez L. Cross-sectional study on the adherence to malaria guidelines in lakeshore facilities of Buyende and Kaliro districts. Uganda Malar J. 2018;17:432.","journal-title":"Uganda Malar J"},{"issue":"10","key":"3729_CR8","doi-asserted-by":"publisher","first-page":"e0132964","DOI":"10.1371\/journal.pone.0132964","volume":"10","author":"J Adinan","year":"2015","unstructured":"Adinan J, Damian DJ, Msuya SE. Factors associated with testing and prompt use of recommended antimalarials following malaria diagnosis: a secondary analysis of 2011\u201312 Tanzania HIV and malaria indicator survey data. PLoS ONE. 2015;10(10):e0132964.","journal-title":"PLoS ONE"},{"key":"3729_CR9","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/1475-2875-7-53","volume":"7","author":"CIR Chandler","year":"2008","unstructured":"Chandler CIR, Jones C, Boniface G, Juma K, Reyburn H, Whitty CJM. Guidelines and mindlines: why do clinical staff over-diagnose malaria in Tanzania? A qualitative study. Malar J. 2008;7:53.","journal-title":"Malar J"},{"key":"3729_CR10","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.4269\/ajtmh.16-0955","volume":"97","author":"KJ Bruxvoort","year":"2017","unstructured":"Bruxvoort KJ, Leurent B, Chandler CIR, Ansah EK, Baiden F, Bjorkman A, et al. The impact of introducing malaria rapid diagnostic tests on fever case management: a synthesis of ten studies from the ACT consortium. Am J Trop Med Hyg. 2017;97:1170\u20139.","journal-title":"Am J Trop Med Hyg"},{"key":"3729_CR11","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1186\/s12916-015-0346-z","volume":"13","author":"B Cundill","year":"2015","unstructured":"Cundill B, Mbakilwa H, Chandler CIR, Mtove G, Mtei F, Willetts A, et al. Prescriber and patient-oriented behavioural interventions to improve use of malaria rapid diagnostic tests in Tanzania: facility-based cluster randomised trial. BMC Med. 2015;13:118.","journal-title":"BMC Med"},{"key":"3729_CR12","volume-title":"Malaria Indicator survey 2013\u20132014","author":"National Malaria Control Programme Uganda Ministry of Health","year":"2014","unstructured":"National Malaria Control Programme Uganda Ministry of Health. Malaria Indicator survey 2013\u20132014. Kampala: National Malaria Control Programme Uganda Ministry of Health; 2014."},{"key":"3729_CR13","doi-asserted-by":"publisher","first-page":"1212","DOI":"10.1136\/bmj.38251.658229.55","volume":"329","author":"H Reyburn","year":"2004","unstructured":"Reyburn H, Mbatia R, Drakeley C, Carneiro I, Mwakasungula E, Mwerinde O, et al. Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study. BMJ. 2004;329:1212\u20135.","journal-title":"BMJ"},{"key":"3729_CR14","doi-asserted-by":"publisher","first-page":"e2012036","DOI":"10.4084\/mjhid.2012.036","volume":"4","author":"Z Bisoffi","year":"2012","unstructured":"Bisoffi Z, Gobbi F, Buonfrate D, Van den Ende J. Diagnosis of malaria infection with or without disease. Mediterr J Hematol Infect Dis. 2012;4:e2012036.","journal-title":"Mediterr J Hematol Infect Dis"},{"key":"3729_CR15","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1186\/1475-2875-9-240","volume":"9","author":"V D\u2019Acremont","year":"2010","unstructured":"D\u2019Acremont V, Lengeler C, Genton B. Reduction in the proportion of fevers associated with Plasmodium falciparum parasitaemia in Africa: a systematic review. Malar J. 2010;9:240.","journal-title":"Malar J"},{"key":"3729_CR16","volume-title":"T3: Test. Treat. Track. Scaling up diagnostic testing, treatment and surveillance for malaria","author":"World Health Organization","year":"2013","unstructured":"World Health Organization. T3: Test. Treat. Track. Scaling up diagnostic testing, treatment and surveillance for malaria. Geneva: World Health Organization; 2013."},{"key":"3729_CR17","doi-asserted-by":"publisher","DOI":"10.30875\/7e6f8c91-en","volume-title":"World malaria report 2019","author":"World Health Organization","year":"2019","unstructured":"World Health Organization. World malaria report 2019. Geneva: World Health Organization; 2019."},{"key":"3729_CR18","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/1475-2875-11-44","volume":"11","author":"A Namagembe","year":"2012","unstructured":"Namagembe A, Ssekabira U, Weaver MR, Blum N, Burnett S, Dorsey G, et al. Improved clinical and laboratory skills after team-based, malaria case management training of health care professionals in Uganda. Malar J. 2012;11:44.","journal-title":"Malar J"},{"key":"3729_CR19","doi-asserted-by":"publisher","first-page":"826","DOI":"10.4269\/ajtmh.2008.79.826","volume":"79","author":"U Ssekabira","year":"2008","unstructured":"Ssekabira U, Bukirwa H, Hopkins H, Namagembe A, Weaver MR, Sebuyira LM, et al. Improved malaria case management after integrated team-based training of health care workers in Uganda. Am J Trop Med Hyg. 2008;79:826\u201333.","journal-title":"Am J Trop Med Hyg"},{"key":"3729_CR20","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1186\/1475-2875-7-199","volume":"7","author":"B Ngasala","year":"2008","unstructured":"Ngasala B, Mubi M, Warsame M, Petzold MG, Massele AY, Gustafsson LL, et al. Impact of training in clinical and microscopy diagnosis of childhood malaria on antimalarial drug prescription and health outcome at primary health care level in Tanzania: a randomized controlled trial. Malar J. 2008;7:199.","journal-title":"Malar J"},{"key":"3729_CR21","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1093\/cid\/ciy478","volume":"68","author":"E Arinaitwe","year":"2019","unstructured":"Arinaitwe E, Dorsey G, Nankabirwa JI, Kigozi SP, Katureebe A, Kakande E, et al. Association between recent overnight travel and risk of malaria: a prospective cohort study at 3 sites in Uganda. Clin Infect Dis. 2019;68:313\u201320.","journal-title":"Clin Infect Dis"},{"key":"3729_CR22","doi-asserted-by":"publisher","first-page":"e0217414","DOI":"10.1371\/journal.pone.0217414","volume":"14","author":"MF Finda","year":"2019","unstructured":"Finda MF, Moshi IR, Monroe A, Limwagu AJ, Nyoni AP, Swai JK, et al. Linking human behaviours and malaria vector biting risk in south-eastern Tanzania. PLoS ONE. 2019;14:e0217414.","journal-title":"PLoS ONE"},{"key":"3729_CR23","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1186\/1475-2875-12-203","volume":"12","author":"HM Koenker","year":"2013","unstructured":"Koenker HM, Loll D, Rweyemamu D, Ali AS. A good night\u2019s sleep and the habit of net use: perceptions of risk and reasons for bed net use in Bukoba and Zanzibar. Malar J. 2013;12:203.","journal-title":"Malar J"},{"key":"3729_CR24","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1186\/1475-2875-13-82","volume":"13","author":"A Monroe","year":"2014","unstructured":"Monroe A, Harvey SA, Lam Y, Muhangi D, Loll D, Kabali AT, et al. \u201cPeople will say that i am proud\u201d: a qualitative study of barriers to bed net use away from home in four Ugandan districts. Malar J. 2014;13:82.","journal-title":"Malar J"},{"key":"3729_CR25","doi-asserted-by":"publisher","first-page":"1375","DOI":"10.1093\/ije\/dyn146","volume":"37","author":"T BagodUva","year":"2008","unstructured":"BagodUva T, Odonnell O, Van Doorslaer E. Differential health reporting by education level and its impact on the measurement of health inequalities among older Europeans. Int J Epidemiol. 2008;37:1375\u201383.","journal-title":"Int J Epidemiol."},{"key":"3729_CR26","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1038\/nature15535","volume":"526","author":"S Bhatt","year":"2015","unstructured":"Bhatt S, Weiss DJ, Cameron E, Bisanzio D, Mappin B, Dalrymple U, et al. The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature. 2015;526:207\u201311.","journal-title":"Nature"},{"key":"3729_CR27","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1002\/anr.1790020406","volume":"2","author":"LF Callahan","year":"1989","unstructured":"Callahan LF, Smith WJ, Pincus T. Self-report questionnaires in five rheumatic diseases comparisons of health status constructs and associations with formal education level. Arthritis Rheum. 1989;2:122\u201331.","journal-title":"Arthritis Rheum"},{"key":"3729_CR28","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1080\/17441692.2010.539573","volume":"7","author":"KL Dickinson","year":"2012","unstructured":"Dickinson KL, Randell HF, Kramer RA, Shayo EH. Socio-economic status and malaria-related outcomes in Mvomero District. Tanzania Glob Public Health. 2012;7:384\u201399.","journal-title":"Tanzania Glob Public Health"},{"key":"3729_CR29","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1086\/655688","volume":"51","author":"V D\u2019Acremont","year":"2010","unstructured":"D\u2019Acremont V, Malila A, Swai N, Tillya R, Kahama-Maro J, Lengeler C, et al. Withholding antimalarials in febrile children who have a negative result for a rapid diagnostic test. Clin Infect Dis. 2010;51:506\u201311.","journal-title":"Clin Infect Dis"},{"key":"3729_CR30","doi-asserted-by":"publisher","first-page":"1896","DOI":"10.1016\/S0140-6736(04)17446-1","volume":"364","author":"M Amexo","year":"2004","unstructured":"Amexo M, Tolhurst R, Barnish G, Bates I. Malaria misdiagnosis: effects on the poor and vulnerable. Lancet. 2004;364:1896\u20138.","journal-title":"Lancet"},{"key":"3729_CR31","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/1475-2875-7-33","volume":"7","author":"JCC Hume","year":"2008","unstructured":"Hume JCC, Barnish G, Mangal T, Arm\u00e1zio L, Streat E, Bates I. Household cost of malaria overdiagnosis in rural Mozambique. Malar J. 2008;7:33.","journal-title":"Malar J"}],"container-title":["Malaria Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-021-03729-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12936-021-03729-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-021-03729-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,15]],"date-time":"2021-04-15T10:51:41Z","timestamp":1618483901000},"score":1,"resource":{"primary":{"URL":"https:\/\/malariajournal.biomedcentral.com\/articles\/10.1186\/s12936-021-03729-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,15]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["3729"],"URL":"https:\/\/doi.org\/10.1186\/s12936-021-03729-8","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-116127\/v1","asserted-by":"object"}]},"ISSN":["1475-2875"],"issn-type":[{"value":"1475-2875","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,15]]},"assertion":[{"value":"24 November 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 April 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Delcarations"}},{"value":"Ethical approvals were obtained from the School of Medicine Research and Ethics Committee (SOMREC) of Makerere University College of Health Sciences, and the Uganda National Council of Science and Technology. Administrative approvals were sought from Kampala City Council Authority and Kisenyi Health Centre IV administration. Written informed consent was obtained from all participants before data collection.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate:"}},{"value":"All authors held final responsibility for the decision to submit and consented to this publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors declare no conflict of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}}],"article-number":"187"}}