How Nigeria's health sector can reduce misdiagnosis

How often do you visit a hospital to complain about a fever, headache, and nausea, then get diagnosed with malaria? If you're in Nigeria, most likely, often. And many times, the diagnosis is accurate.

Some takeaways:

Medical misdiagnosis is quite common among patients and doctors in Nigeria. A study found that about 42% of women and 54% of men who tested negative for malaria still used malaria medication.
Misdiagnosis often happens when the doctors or health practitioners who test patients are unfamiliar with the disease and lack the infrastructure to conduct thorough tests.
Private firms like 54gene and research cluster led by Dr Christian Happi, a professor of genomics and virology at Redeemers University Ede, are leading the path to solving low testing capacity in Nigeria.

However, it's also likely that the malaria medication you got was not a solution for the pain and discomfort you were feeling. That’s because malaria shares some of the highly recognisable symptoms with more severe or fatal diseases like typhoid and Covid-19. So, it’s not uncommon to hear of misdiagnosis.

In fact, I found some (shocking) research to back this up. For instance, in Sokoto, 800 children who were febrile—ran high temperatures—were diagnosed with malaria, only to discover that less than 500 of them had the disease. This data is even more jarring when you realise that the remaining 300 people may have had viral illnesses that put their families and healthcare practitioners at risk.

The same study recorded that less than three people had malaria in Borno state out of the 300 people diagnosed with malaria. More than 200 of them had more life-threatening and viral diseases.

Such misdiagnosis happens at different points of care. People who self medicate, for instance, claim that they know the cause of their disease and misdiagnose themselves. This is sometimes because they cannot afford to get tested or they do not think the illness warrants a doctor's visit.

And this is pretty common. On average, when people fall ill, less than 20% of them visit healthcare practitioners; over 47% visit a chemist—ranging from people who peddle drugs in suitcases and hawk them to people who own small drug dispensaries.

But, money is the main reason why people don't go to hospitals. To understand this better, I spoke with Lola Alli, the Co-founder of the Lagos Executive Cardiovascular Center. She confirmed that the main issue with accessing quality healthcare in Nigeria is affordability. The National Bureau of Statistics (NBS) estimates that a visit to a hospital could cost ₦3,000 (transportation and medication inclusive). That's essentially 10% of the country's ₦30,000 minimum wage, which about 60% of the country lives on. That leaves many people struggling to pay the fee for a malaria test at a good lab or hospital in Lagos. So what do they do? They self-diagnose.

So, when people have a fever, they pop an anti-malaria pill and keep it moving.

In some cases, even after people go to the hospital for a test, they don't trust the doctor's diagnosis and still misdiagnose themselves. A report on improving malaria case management in Nigeria by Breakthrough ACTION recorded that 42% of women and 54% of men who tested negative for malaria still went ahead to use malaria medication.