Whilst working in a rural hospital in Ghana last year I also observed many patients being treated for malaria despite negative microscopy. The hospital dedicated its limited resources to providing an efficient microscopy service and so it was striking that clinicians held the results in such low esteem.

The clinicians maintained that they worked in an endemic area and this fact was used to justify mistreatment of microscopy-negative patients. The laboratory staff were far more familiar with the local incidence of malaria and the seasonal variance in their results. Sadly, my efforts to encourage better communication between clinicians and the laboratory met with little success. I wonder if the authors of this study had any more luck encouraging local clinicians to trust microscopy results?

Competing interests: None declared