Funduscopy in Cerebral Malaria Diagnosis: An International Survey of Practice Patterns

Abstract

Cerebral malaria (CM) is a significant cause of mortality and morbidity in sub-Saharan Africa, particularly among young children. Malarial retinopathy is the most specific clinical finding in CM, and fundus examination could help clinicians distinguish CM from other causes of encephalopathy in resource-poor areas. To assess clinician knowledge, practice patterns, and barriers to the use of funduscopy in the diagnosis of CM, we designed a descriptive multinational survey of clinicians in malaria endemic areas. Results of this survey showed that 19% of respondents were not aware of the utility of eye examinations for malarial retinopathy, and almost half (49%) never or almost never examine the eyes in cases of suspected CM. Educating clinicians about malarial retinopathy could be important in improving diagnostic specificity for CM.

Figure 1.

Geographic distribution of survey responses. Locations were mapped primarily using user-reported city and country information, and geographic coordinates of Internet Protocol addresses in cases where location was not provided by the user. Google Maps image used here in accordance with Google’s Permissions Policy; map data from Google Maps and National Institute of Statistics and Geography, Mexico (INEGI). Locations plotted using Map Tool by Darrin Ward, with permission. This figure appears in color at www.ajtmh.org.

Figure 2.

Funduscopic practice patterns and barriers. (A) Respondents were asked about current behavior, “How often do you (or another clinician) examine the retinas of your patients suspected of cerebral malaria?” (top) and about likelihood to perform funduscopy in a hypothetical case, “Imagine that you suspect one of your patients to have cerebral malaria. How likely are you to perform or order a funduscopic exam of the eyes?” (bottom). N = 53, Cronbach’s alpha=0.96. (B) Frequency of answers to the question, “What are the barriers to performing funduscopy on patients suspected of having cerebral malaria?” N = 52. (C). “Which of the following would help you perform ocular fundus examination of patients with suspected cerebral malaria?” N = 54.