BACKGROUND: Malaria is one of the world’s greatest public health problems. Although endemic malaria was eradicated from Florida in the late 1940s, Florida reports an average of 77 cases of malaria per year in travelers returning from endemic regions. This survey aims to understand malaria knowledge and practice in hospitals to identify areas for improvement in case management.
METHODS: Questions for the clinician survey were developed to collect information on clinician knowledge and practice. A separate laboratorian survey collected information on malaria testing availability and timeliness. Surveys were distributed to physicians and laboratorians in Florida hospitals by epidemiology staff at local county health departments.
RESULTS: A total of 52 physician and 52 laboratory surveys were received from 63 of 246 surveyed hospitals. This represents 29 of Florida’s 67 counties and 26 of 36 counties with a population greater than 100,000. The majority of physicians surveyed were either emergency department (43%) or infectious disease (43%) physicians with more than five years of experience (85%); 58% had diagnosed malaria in the past. Only 44% of physicians always asked for a patient’s travel history, and only 15% could correctly identify countries with endemic transmission. While all physicians identified fever as a symptom of malaria, 40% did not know nausea/vomiting and diarrhea are also symptoms. Physicians differed on when malaria treatment should be started, before (61%) or after testing (37%); only 10% of physicians correctly identified instances of when to use intravenous artesunate. Many of the hospitals surveyed had the capacity to perform blood smears (61%), while 85% had staff trained to perform manual complete blood cell counts. However, several physician and laboratory surveys from the same hospital differed in the testing capabilities reported as well as the timing of testing results. Most hospital laboratories (58%) had performed malaria testing in the past year, but 20% had no testing available in house. Only 14% of hospital labs had rapid antigen tests available.
CONCLUSIONS: The results of this survey identify areas needing targeted education for both physicians and laboratorians. Persons with compatible symptoms and a known travel history to malaria-endemic areas should be evaluated for malaria. Testing should be prompt in order to avoid delays in treatment. Laboratorians may not realize that skills used in performing manual blood cell differentials can be applied to perform a preliminary malaria smear screen. The use of rapid diagnostic tests for malaria, such as Binax NOW, can also aid in a preliminary diagnosis.