Leukocytosis in Negative Malaria Rapid Diagnostic Test Febrile Illness Among Children Under Five Years in a District Hospital

Background: Definitive tests are not routinely available in Ghanaian district hospitals for diagnosing febrile illnesses among children under five years after excluding malaria with the rapid diagnostic test (RDT). Most of such febrile presentations are likely microbial. If an infection-induced WBC elevation is demonstrated consistently enough in such malaria-RDT negative febrile illnesses, it could become a diagnostic aid. Methods: Retrospective data from the clinical records were obtained for 432 children from 6 months to 5 years of age, who had presented with fever (temperature ≥ 37.5°C). Their respective WBC counts were also documented and statistical analysis of the data carried out. Results: A significant relationship was demonstrated between the malaria-RDT negative status and the patient’s elevated WBC count (P < 0.001). Leukocytosis was absent in 58.6% of RDT-negative febrile children. Patients who tested RDT-negative were twice as likely to have elevated WBC counts (OR = 2.19) than RDT-positive patients. Conclusions: An elevated WBC count has demonstrated a potentially weak relationship with a negative malaria-RDT status among febrile children U-5 in DPH. Standing alone, however, the WBC may not be decisive for the evaluation of U-5 febrile presentations after excluding malaria.