THE EFFICACY OF THE METHODS USED TO TEST FOR MALARIA AND TYPHOID (RDT AND FULL BLOOD COUNT) AT DUTSE GENERAL HOSPITAL

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Malaria and typhoid fever remain among the most significant public health problems globally, especially in sub-Saharan Africa where poverty, poor sanitation, and inadequate healthcare infrastructure exacerbate their prevalence. According to the World Health Organization (WHO, 2022), malaria accounted for approximately 247 million cases and 619,000 deaths worldwide in 2021, with Nigeria alone contributing about 31% of global cases and 27% of deaths. Typhoid fever, on the other hand, is estimated to cause nearly 11–20 million cases annually worldwide, with the majority of cases occurring in developing countries with poor water supply and hygiene conditions (Crump & Mintz, 2010). These statistics highlight the enormous burden both diseases place on health systems, particularly in low- and middle-income countries like Nigeria.

A major challenge with malaria and typhoid fever is that they present overlapping symptoms such as persistent fever, headache, chills, abdominal pain, and general malaise. This symptomatic similarity often makes it difficult for clinicians to distinguish between the two diseases based on physical examination alone. In many rural and semi-urban communities, health workers sometimes rely solely on clinical diagnosis, which increases the risk of misdiagnosis and inappropriate treatment (Onwuchekwa et al., 2019). Consequently, there is a growing need for reliable laboratory methods that can provide accurate and timely results to guide effective treatment.

Over the years, different diagnostic techniques have been developed and employed in Nigeria. Among the most common are Rapid Diagnostic Tests (RDTs) and Full Blood Count (FBC). RDTs are immunochromatographic tests that detect specific antigens of Plasmodium parasites in the blood or antibodies of Salmonella typhi. They are widely used because they are simple, inexpensive, and can deliver results in less than 30 minutes without the need for sophisticated equipment. The WHO (2018) recommends RDTs as an alternative to microscopy in resource-limited settings, particularly for malaria. However, several studies have shown that the sensitivity and specificity of RDTs vary depending on factors such as storage conditions, the prevalence of infection, and operator skill (Ochola-Oyier et al., 2021). This variability raises concerns about their reliability in routine healthcare delivery.

Full Blood Count (FBC), on the other hand, is a hematological test that evaluates different blood components, including red blood cells, white blood cells, hemoglobin concentration, and platelets. While FBC does not directly detect malaria parasites or typhoid bacteria, abnormal blood patterns such as anemia, leukopenia, and thrombocytopenia may serve as supportive evidence for infection (Khan et al., 2018). For example, malaria is often associated with reduced hemoglobin levels and platelet counts, whereas typhoid fever may present with leukopenia or mild anemia. In Nigeria, FBC is commonly used in combination with clinical judgment to enhance diagnostic accuracy. Nonetheless, its inability to definitively confirm infection limits its role as a standalone diagnostic tool.

1.2 Statement of the Research Problem

Malaria and typhoid fever are among the leading causes of morbidity and mortality in Nigeria, particularly in Jigawa State, where poor sanitation, limited access to potable water, and inadequate healthcare infrastructure facilitate the spread of these infectious diseases. Both illnesses share overlapping clinical symptoms such as prolonged fever, headache, fatigue, and abdominal discomfort, which makes it extremely difficult for healthcare providers to distinguish between the two based on clinical presentation alone. This diagnostic overlap often leads to misdiagnosis and inappropriate treatment, posing a major challenge to effective healthcare delivery (Uneke, 2008; WHO, 2022).

At Dutse General Hospital, Rapid Diagnostic Tests (RDTs) and Full Blood Count (FBC) are the two most commonly used methods for detecting malaria and typhoid fever. While RDTs are fast, affordable, and convenient, several studies have questioned their sensitivity and specificity, especially in cases of low parasitemia or cross-reactivity with other febrile illnesses (Endeshaw et al., 2019). Similarly, although FBC provides hematological profiles that are useful in assessing infection, it is not disease-specific and may only indicate general signs of infection such as anemia, leukopenia, or thrombocytopenia, which can be caused by several conditions unrelated to malaria or typhoid.

1.3 Aim and Objectives of the Study

1.3.1 Aim:

The aim of this study is to assess the efficacy of Rapid Diagnostic Tests (RDT) and Full Blood Count (FBC) in diagnosing malaria and typhoid at Dutse General Hospital.

1.3.2 Objectives:

1. Evaluate the accuracy of RDT in diagnosing malaria and typhoid.
2. Assess the role of Full Blood Count in supporting malaria and typhoid diagnosis.
3. Compare the strengths and limitations of RDT and FBC in disease detection.
4. Determine the level of confidence healthcare workers place in these diagnostic methods.

1.4 Research Questions

This study seeks to answer the following questions:

1. How accurate is RDT in diagnosing malaria and typhoid at Dutse General Hospital?
2. What role does Full Blood Count play in the diagnosis of malaria and typhoid?
3. What are the strengths and limitations of RDT compared to FBC?
4. How confident are healthcare workers in using these diagnostic methods?

1.5 Significance of the Study

This study is significant in several respects. Firstly, it will provide empirical evidence on the effectiveness of diagnostic tools used in Dutse General Hospital, which can guide clinicians in selecting the most reliable methods. For patients, accurate diagnosis will help reduce cases of misdiagnosis, inappropriate treatment, and prolonged illness. For healthcare workers, the findings will improve diagnostic decision-making and promote evidence-based practice.

At the policy level, this research will contribute to healthcare improvement in Jigawa State by informing the Ministry of Health and other stakeholders on better strategies for combating malaria and typhoid. Finally, the study will also serve as a useful reference for academics and future researchers, thereby adding to the body of knowledge on infectious disease management in Nigeria.

1.6 Scope and Limitations of the Study

This study is limited to Dutse General Hospital, Jigawa State. It focuses on evaluating the efficacy of RDT and Full Blood Count as diagnostic methods for malaria and typhoid among patients attending the hospital. The study does not cover other diagnostic methods such as blood culture, Widal test, or advanced molecular techniques like PCR due to cost and time constraints.

Another limitation is that the study relies on hospital-based data, which may not fully represent the diagnostic challenges in rural clinics or private hospitals. Additionally, variations in the competence of laboratory personnel may influence test outcomes. Despite these limitations, the study provides valuable insights into the practical realities of malaria and typhoid diagnosis in a key healthcare facility.

1.7 Definition of Key Terms

To provide clarity and ensure a common understanding of the concepts used in this study, the following key terms are defined:

Malaria: Malaria is a life-threatening parasitic disease caused by Plasmodium species, most commonly Plasmodium falciparum in sub-Saharan Africa, and transmitted through the bite of infected female Anopheles mosquitoes. It is characterized by symptoms such as fever, chills, headache, and anemia. In Nigeria, malaria is endemic and remains one of the leading causes of morbidity and mortality (World Health Organization [WHO], 2022).

Typhoid Fever: Typhoid fever is a systemic bacterial infection caused primarily by Salmonella enterica serotype Typhi. It is transmitted through ingestion of contaminated food or water and manifests with prolonged fever, abdominal pain, weakness, and gastrointestinal disturbances. Typhoid remains a major public health problem in developing countries due to poor sanitation and limited access to clean water (Crump & Mintz, 2010).

Rapid Diagnostic Test (RDT): RDTs are immunochromatographic tests designed to quickly detect the presence of malaria parasites or typhoid-specific antigens in a patient’s blood sample. They provide results within 15–20 minutes and are widely used in resource-limited settings because they do not require advanced laboratory infrastructure (Endeshaw et al., 2019).

Full Blood Count (FBC): FBC, also known as complete blood count (CBC), is a routine hematological test that measures the levels of red blood cells, white blood cells, hemoglobin, hematocrit, and platelets in the blood. While not disease-specific, FBC provides important information about the general health status of a patient and can suggest infections such as malaria and typhoid through changes like anemia, leukopenia, or thrombocytopenia (Bain, 2015).

Efficacy: In this study, efficacy refers to the ability of a diagnostic method RDT or FBC to accurately detect malaria and typhoid infections in patients. It encompasses sensitivity, specificity, and reliability in providing correct diagnostic outcomes (Hayes, 2013).

Diagnosis: Diagnosis is the process of identifying a disease or condition in a patient based on the evaluation of symptoms, clinical signs, and laboratory tests. Accurate diagnosis is critical to ensuring effective treatment and reducing morbidity and mortality (Fletcher et al., 2019).

Dutse General Hospital: This refers to the major secondary healthcare facility located in Dutse, the capital of Jigawa State, Nigeria. The hospital serves as a referral center for various healthcare needs and plays a vital role in malaria and typhoid testing and treatment in the region.

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