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