Under-Diagnosis of Severe Conditions Requiring Urgent Referral in Children in Developing Countries: An Under Appreciated Problem

Ray Langsten, American University in Cairo
Susan S.I. Khalil, Ain Shams University
Mahmoud el-Mougi, Al-Azhar University, Cairo

Under-diagnosis of severe conditions requiring urgent referral is widespread in developing countries. Assessment, diagnosis, and treatment provided by government physicians to 579 children under 5 years of age was observed and compared to a gold standard determined by well-trained physician-observers. This work focuses on the 38 children determined by the observers to be suffering from serious illness warranting immediate admission or referral to a hospital. 87 % of children suffering from serious illness were under-diagnosed by the government physicians. Under-diagnosis results largely from hurried and incomplete assessment. 74% of children requiring urgent referral were under-treated, putting them at greater risk of death. High levels of under-diagnosis and under-treatment of serious illness have been reported in other studies, but have been given little attention. Our purpose is to raise awareness about this serious problem.