The malaria status amongst some patients at an elite hospital in Abuja, Nigeria was
investigated from May 2000 to December 2010. Of the 80 947 patients blood samples analyzed with
Giemsa staining methodology, 26 593 (32.9%) were positive for malaria parasites. Of the positive cases
encountered 13 (0.05%) were Plasmodium malariae; 2 mixed infections of P. falciparum and P. vivax;
one mixed infection of P. falciparum and P. malariae; while the rest (99.9%) were P. falciparum. A case
of mixed infection of P. falciparum and microfilariae of Mansonella perstans was also encountered. Of
the 26 593 positive samples, 506 (1.9%) had parasite density of >5000 parasites/µl of blood; 970 (3.6%)
had between 500 – 5000 parasites/µl of blood; 3744 (14.1%) had between 50 – 500 parasites/µl of blood;
while 21 373 (80.4%) had between 5 – 50 parasites/µl of blood. The parasite detection limit of Giemsa
stained thick blood film microscopy is 5 parasites/µl of blood as against that of Malaria Rapid
Diagnostic Tests (M-RDTs) that have a detection limit of 397 – 500 parasites/µl of blood. The implication
of the continued use of these malaria rapid diagnostic test methodologies includes underdiagnosis,
misdiagnosis of malaria and mismanagement of non-malarial fever, which wastes limited resources,
erodes confidence in the health care system, and contributes to drug resistance. In conclusion, there is
the need to incorporate the laboratory component into the RBM strategy by enhancing parasitological
diagnosis by way of providing microscopic diagnostic tolls at all levels of health care – primary (rural
settings), secondary and tertiary.