Hindawi Publishing Corporation ISRN Infectious Diseases Volume 2013, Article ID 914675, 6 pages http://dx.doi.org/10.5402/2013/914675 Research Article Overdiagnosis and Overtreatment of Malaria in Children That Presented with Fever in Lagos, Nigeria Oladipo O. Oladosu, 1 and Wellington A. Oyibo 1, 2 1 ANDI Centre of Excellence for Malaria Diagnosis and College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria 2 ANDI Centre of Excellence for Malaria Diagnosis, International Malaria Microscopy Training and RDT QA Programme, WHO/TDR/FIND Malaria Specimen Bank Site, and Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria Correspondence should be addressed to Wellington A. Oyibo; wellao@yahoo.com Received 5 April 2012; Accepted 17 May 2012 Academic Editors: D. Bachani, T. Hazir, M. Ramharter, F. Remoue, and E. Seminari Copyright © 2013 O. O. Oladosu and W. A. Oyibo. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Malaria diagnosis has been largely done clinically. e implication is the likely overdiagnosis of malaria when diagnosis is done soley on the basis of symptoms. Methods. Parasitological diagnosis was done among 1211, 0–12 years old febrile children that attended a Primary Health Centre in Lagos, Nigeria, who were diagnosed clinically and treated based on symptoms. Results. A total of 251 of 1,211 (20.7%) children less than 12 years old and 174 of the 1,027 of children 0–≤5 yrs (16.9%) were slide positive while 853 (83.1%) of 0–≤5 yrs that were slide negative were treated with Artemisinin based combination therapies (ACTs) in line with the Integrated Management of Childhood Infectioins (IMCI) guidelines and standard practice of the Clinic. Chills, diarrhoea, convulsions, headache, cough, respiratory distress, inactivity, loss of apetite, and vomiting occured signi�cantly in the 0–≤5 and >5–12 years old malaria negative children. Conclusions. Overdiagnosis and overtreatment of malaria in this study was high. erefore, malaria medicines should be prescribed on the basis of parasitological con�rmation of all suspected malaria cases. e availability of �uality-assured malaria rapid diagnostic tests (RDTs) is a useful tool to con�rm malaria cases while the cause of the non-malaria fevers can be followed up and managed appropriately. 1. Introduction In areas of intense malaria transmission, such as large parts of tropical Africa, where the burden of malaria is greatest and where severe disease and mortality are largely con�ned to children under 5 years of age, malaria treatment is oen dispensed on the basis of “fever” and other malaria- associated symptoms such as chills, headache, vomiting, respiratory distress and so forth, rather than on the basis of a parasitologically con�rmed diagnosis. is is also mainly due to the wholesale implementation of the Integrated Management of Childhood Illness guidelines [1]. One of the reasons for presumptive treatment is the fear of rapid mortality of untreated malaria, especially in young children. Until recently, the diagnosis of malaria in children in most African setting was on the clinical basis of fever and other malaria related symptoms that are, however, not speci�c to malaria alone. e clinical presentation of malaria is highly variable and overlaps with that of a number of other common illnesses, including pneumonia, which are associated with signi�cant morbidity and mortality [2–4]. e policy of presumptive treatment of malaria for all febrile illnesses has been widely advocated in sub-Saharan Africa, especially in young children [5, 6]. Attempts to develop clinical scoring systems with high predictive values have largely been unsuccessful [7], and health workers without access to tools for parasite-based diagnosis oen manage most or all suspected malaria cases as malaria. is practice continues to be included in medical training and in national treatment guidelines [8]. Presumptive management of fevers and/or other sus- pected symptoms of malaria as malaria results in signi�cant