Repeated sampling improved the sensitivity of malaria microscopy in children under six years.

Objective: Microscopy remains the gold standard for identification of malaria parasites. However, the sensitivity of malaria microscopy is low. This study evaluated the impact of repeated sampling up to 12 h in 177 children < 6 years with suspected malaria.

Results: The median age was 3 years (interquartile range, 2.0-4.0 years). Eighty-nine percent (158/177) presented with hyperthermia together with one or more of the following symptoms: chills, headache, sweating, fatigue, nausea, abdominal pain, vomiting, diarrhea and cough. Baseline microscopy confirmed malaria in 29.9% (53/177) of the suspects. Repeated testing at 6 and 12 h increased the positive detection rates to 35.0% (62/177) and 41.8% (74/177), respectively. Microscopy underestimated malaria diagnosis by 11.9% on single testing. Children showing classical signs of malaria but with initial negative parasitological reports should be retested between 6 to 12 h to confirm or rule out a diagnosis of malaria.