Patient outcome
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Patient likely to be cured if malaria parasites present
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Patient likely to be cured if no malaria parasites present at low endemicity, or even if parasitaemic at high endemicity (co-morbidity)
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Diagnostic support
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Easy and quick to diagnose and treat
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More complicated diagnosis and treatment
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Malaria is easier to diagnose than alternatives
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Perceived as easily recognisable
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Alternative diseases perceived as less specific
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Fewer tests needed for confirmation
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Increased number and complexity of tests (e.g. lumbar puncture)
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Feel confident to diagnose clinically
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Clinical diagnosis less clear, may need to wait for test results
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Laboratory test results may be incorrect (due to resource problems, staff skills) or the parasites may be hidden
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Well established process of malaria diagnosis and treatment
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No set process: if time short or motivation low may be easier to take established path
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No retribution for over-diagnosing malaria
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Lack of supervision or regular advice to consider differential diagnoses
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Disease promotion and training
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Well known disease with frequent training available
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Less well known diseases, less training available
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Guidelines are malaria specific
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Few guidelines for alternative diseases
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Patient preferences
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Perceived as preferable to patients
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Fear of patient complaints if don't test or treat for malaria
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Perceived as acceptable to patients: high profile, low-stigma disease
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More explanation necessary for patients who may prefer the familiarity of malaria
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Malaria is a more acceptable diagnosis
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Peer pressure
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Perceived as acceptable to peers who also see over-diagnosis as preferable to missing malaria
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Alternative diagnoses may require clinicians to justify themselves
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Disease promotion and training
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Malaria promoted by public health campaigns as most important disease
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Alternative diseases less often promoted resulting in lower profile
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Missing malaria is indefensible
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Training emphasises malaria over alternative diseases
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Alternative diseases taught in theory more than practice
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Indefensible to miss malaria, perceived as most important disease
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More defensible to miss alternative causes of disease
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