Repeated sampling improved the sensitivity of malaria microscopy in children under six years

Microscopy remains the gold standard for identification of malaria parasites. However, the sensitivity of malaria microscopy is low. This study evaluated the impact of repeated sampling up to 12 h in 177 children < 6 years with suspected malaria.

The median age was 3 years (interquartile range, 2.0-4.0 years). Eighty-nine percent (158/177) presented with hyperthermia together with one or more of the following symptoms: chills, headache, sweating, fatigue, nausea, abdominal pain, vomiting, diarrhea and cough. Baseline microscopy confirmed malaria in 29.9% (53/177) of the suspects. Repeated testing at 6 and 12 h increased the positive detection rates to 35.0% (62/177) and 41.8% (74/177), respectively. Microscopy underestimated malaria diagnosis by 11.9% on single testing. Children showing classical signs of malaria but with initial negative parasitological reports should be retested between 6 to 12 h to confirm or rule out a diagnosis of malaria.