By Simon Peter Katongole
When sick, the diagnosis a child receives has an important bearing on the treatment he/she gets. Good healthcare practice requires that a right diagnosis is arrived at so that children get accurate treatment. Many times however, illnesses in children are misdiagnosed worsening further the big disease burden already existing in the low income countries. Children’s health is so often affected when they are misdiagnosed upon seeking care in health facilities. Yet, little information is available about child misdiagnosis and few health facilities are tracking it. Many disease symptoms and signs in children are a replication of several diseases, hence various potential diagnoses may be made.
Fever and cough for example, are two common symptoms responsible for child visits at outpatient departments in health facilities and are the leading causes of misdiagnosis in children.Fever remains a major symptom for children’s’ hospital visits in our part of the world, but too often, because of the inadequate diagnostic testing, children are given the wrong diagnosis leading to wrong treatment. A malaria labeling is common for many children with fever.
However, at the time where screening tests are common to confirm or rule out malaria, it is surprising that this problem still occurs. Yet, many times when malaria is confirmed absent, a diagnosis of “bacterial infection” has become common in many children. Similarly, a pneumonia misdiagnosis has been common in children with cough. Relatedly, an Asthma misdiagnosis is common in children with persistent cough for more than 10 days. Consequently, such children have received numerous prescription of needless antibiotics and steroids (drugs to treat inflammation).The misuse of antibiotics and other drugs resulting from misdiagnosis causes drug resistance where drugs become less powerful to cure diseases they are meant to treat. While over and unnecessary use of some drugs such as steroids may have devastating effects to children’s lives. With the increasing non-communicable diseases as a result of changes in behaviour and feeding habits, children today are prone to many non-infectious conditions that most clinicians are not finding easy to diagnose. This is worsened by the reduced diagnostic capacity in many of the health facilities be it private or government. It is therefore important to understand why misdiagnosis is becoming rampant despite the advancement in medicine nowadays.
Some of the reasons for the rampant misdiagnosis in children include avoidable and unavoidable mistakes especially on how health workers think and ways of how they approach children’s illnesses. Lots of diseases look similar and many health workers have a tendency of going with the most common disease. The inadequate diagnostic capacity, the less attention and time by health workers to parents to listen to their complaints about the children’s complaints are other causes of misdiagnosis. Sometimes parents label particular diagnoses to their children with health workers minding less to play their professional role and follow procedures to get the right condition in the child. Parents sometimes via discussions with friends, families and colleagues have a tendency of labelling certain conditions to children. It is astonishing sometimes for parents to label such diagnoses as “family diseases or conditions”. In my own practice, I have often observed some parents wrongly labeling certain skin conditions as “our family Syphilis”.
Sometimes, due to the rush to provide treatment, clinicians end up treating symptomatically what is treatable and make thorough reassessment should the child not get better. On other occasions, the tendency for clinicians to hurriedly close off their thinking and settle at a diagnosis just because certain symptoms fit a certain diagnosis has also contributed to the misdiagnosis problem.
This is worsened by naïve parents who easily get satisfaction by a mere fact that a certain medication has been given to the child regardless of whether the right treatment is being given to the real disease. The rush to treat is also more common in private health facilities especially because a patient never leaves the premises without having to get a medicine to pay for. Since clinicians would want a definite level of certainty of a particular condition that the child is suffering from, on some occasions, they may decide to reassure the parents hence missing out a potential illness.
Sometimes, misdiagnosis may go unnoticed and the child heals despite the wrong diagnosis. However, parents need to be keen with their children’s health and be on a look out especially when children do not get better for the condition their child has been treated for or a re-occurrence of similar signs and symptoms similar to what the child was treated for. It is at this point that as a parent, one may need to seek for another opinion. The same should apply to clinicians when they realize that a condition is unfamiliar to them so that they may seek a second opinion from colleagues or seniors.
While in many developed countries malpractice suits for misdiagnosis have acted as a check on patients and hospitals, the same may not be said of our low income countries where litigation of health practitioners is often unheard of. Consequently, parents need to be empowered to take keen interest in their children’s health. Know your child’s health and as a parent, prepare yourself for your child’s healthcare visit. Seek explanation from your healthcare practitioner during child illness appointments. Be a good reporter of any pertinent information that might be necessary for the diagnosis of your child’s condition and be honest. This may require you to be an active follower of your child’s health. Ask your healthcare practitioner questions for clarification about a child’s disease.
Find out from your doctor, nurse or clinician if there is more than one disease that could be responsible for the symptoms in your child. Get information on the tests needed and why they are being recommended. And when not satisfied, gently ask for a referral to where the child’s condition may appropriately be diagnosed. Do not forget to keep records.
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