Epidemiological basis for clinical diagnosis of childhood malaria in endemic zone in West Africa

Rougemont, André; Brenner, E.; Moret, A.; Breslow, Norman E.; Dumbo, O.; Dolo, Amagana; Soula, G; Perrin, Luc

doi:10.1016/0140-6736(91)92592-p

Cited by 82 publications

(54 citation statements)

References 6 publications

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“…These results are representative of moderate seasonal transmission of malaria, and different from results from other areas, e.g., the Sub-Saharan Africa, were transmission is much more extensive (McElroy et al, 1994;Rogier et al, 2005). In the latter situation, malaria is likely to be the cause of febrile illness in children or in adults with higher parasitemias (Rougemont et al, 1991;McElroy et al, 1994). In areas of low-to-moderate malaria transmission, lesser numbers of exposures retards acquisition of immunity and results in people of all ages suffering from clinical illness when infected.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of clinical algorithm as screening process to detected malaria in low-to-moderate transmission areas of scarce health related resources

Périssé

Strickland²

2008

Acta Tropica

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Introduction-In areas of low-to-moderate risk of malaria transmission, the World Health Organization recommends parasitic confirmation before treatment. Such areas have usually low budget for health care and malaria diagnosis is mostly based on clinical assumption. Algorithms have been developed to improve health care providers' identification of clinical malaria and could be used as screening to reduce the number of individuals requiring parasitic confirmation before treating.Methods-Prospective clinical and parasitological data were collected from inhabitants of four villages from March 1984 through March 1985. Symptoms and signs recorded by physicians were used in multivariate models to test the best predictors of malaria. Sensitivity and specificity were calculated for various cut-offs of scores and compared to clinical diagnosis.Results-A total of 8.941 individuals were evaluated during the 1-year period of data collection. The overall prevalence of malaria parasitemia was 19.7% (n = 1762). Of the 4280 people evaluated during the high season period, 24% (n = 1024) presented any parasitemia, 55.3% (566/1024) due to Plasmodium falciparum. The final clinical algorithm included history of fever, rigors, headache, absence of myalgia, backache or cough, nausea or vomiting, and splenomegaly on examination as predictable variables. At a cut-off score of 2.0, the sensitivity of the algorithm was higher for the entire sample (57% vs. 43%), for high season period (70% vs. 53%), for children less than 6 years of age (59% vs. 40%), for individuals with parasitemia due to P. falciparum (65% vs. 48%), and for high P. falciparum parasitemic individuals at high season (84% vs. 68%). However, specificity was usually lower unless a higher cut off was used, in which case the gain in sensitivity by using the algorithm was reduced.Conclusion-In low-to-moderate transmission areas in which health related resources are scarce, a clinical algorithm increases the identification of real cases of malaria and could be used as screening for further parasitic identification.

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Section: Discussionmentioning

confidence: 99%

Usefulness of clinical algorithm as screening process to detected malaria in low-to-moderate transmission areas of scarce health related resources

Périssé

Strickland²

2008

Acta Tropica

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“…rapid diagnostic tests - RDTs) is high, whereas in high-transmission areas the reverse is the case[6]. In children in a high-transmission setting, during the rainy season, high fever of short duration, with no other obvious cause, is most likely to be malaria [7]. In some such settings over 80% of febrile patients (all ages) with presumed malaria are parasite positive, and the "test and treat" strategy is not cost-effective, particularly in children and where the cost of treatment is lower than that of the test [8,9].…”

Section: Review Of the Evidence For The Assumptions Underlying Who's mentioning

confidence: 99%

"Test and treat" or presumptive treatment for malaria in high transmission situations? A reflection on the latest WHO guidelines

Graz

Willcox

Szeless

et al. 2011

Malar J

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Recent WHO guidelines recommend a universal "test and treat" strategy for malaria, mainly by use of rapid diagnostic test (RDT) in all areas. The evidence for this approach is questioned here as there is a risk of over-reliance on parasitological diagnosis in high transmission situations, which still exist. In such areas, when a patient has fever or other malaria symptoms, the presence of Plasmodium spp neither reliably confirms malaria as the cause of the fever, nor excludes the possibility of other diseases. This is because the patient may be an asymptomatic carrier of malaria parasites and suffer from another disease.To allow clinicians to perform their work adequately, local epidemiologic data are necessary. One size does not fit all. If parasite prevalence in the population is low, a diagnostic test is relevant; if the prevalence is high, the test does not provide information of any clinical usefulness, as happens with any test in medicine when the prevalence of the tested characteristic is high in the healthy population. It should also be remembered that, if in some cases anti-malarials are prescribed to parasite-negative patients, this will not increase selection pressure for drug resistance, because the parasite is not there.In high transmission situations at least, other diagnoses should be sought in all patients, irrespective of the presence of malaria parasites. For this, clinical skills (but not necessarily physicians) are irreplaceable, in order to differentiate malaria from other causes of acute fever, such as benign viral infection or potentially dangerous conditions, which can all be present with the parasite co-existing only as a "commensal" or silent undesirable guest.

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“…In recent times when most healthcare facilities have the capacity to diagnose malaria in well-equipped laboratories, some clinicians still seek to presumptively diagnose children less than five years who present with fever as having malaria (Reyburn et al, 2006;English et al, 2009). This has led to calls for patients to be pre-tested for the presence of malaria parasites before treatment is initiated (Rougemont et al, 1991;Reyburn et al, 2006;English et al, 2009). The purpose of this study therefore, was to establish the prevalence of malaria coexisting with UTI among children <5 years in the Assin South municipality and to further assess the antimicrobial susceptibility pattern of the isolated organisms.…”

Section: Introductionmentioning

confidence: 99%

“…For decades, majority of African children under the age of 5 years have been presumptively treated for malaria once they present with fever (Rougemont et al, 1991;Kallander et al, 2004;English et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Co-existence of malaria and urinary tract infection among children under five: A cross-sectional study of the Assin-South Municipality, Ghana

Ephraim¹,

Nyame²,

Sakyi³

et al. 2014

J. Med. Biomed. Sci.

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Across tropical Africa, febrile children are treated for malaria either with or without confirmation thus resulting in failure to diagnose and treat other co-morbidities like urinary tract infections (UTI) and upper respiratory tract infection (URTI) that may coexist with malaria. This crosssectional study examined coexisting malaria with UTI and further assessed the antimicrobial susceptibility pattern of the isolated organisms among children aged <5 years presenting with fever. Between December 2012 and May 2013, 284 children were recruited from the Saint Francis Xavier Hospital, in the Central Region of Ghana through purposive sampling. Thick and thin blood films were used for the diagnosis of malaria and urine samples were collected in sterile, wide-mouthed, leak proof containers for culture and sensitivity. Organisms isolated were identified and tested for their antimicrobial sensitivity patterns using the Kirby-Bauer disc diffusion method. Prevalence of malaria with coexisting UTI was 15.8% with majority (58.0%) of the participants being female. Age was significantly (p=0.025) associated with malaria and UTI co-infection with the highest prevalence of co-infection (35.6%) recorded amongst the 13-24 months age group; gender was not associated with co-infection (p>0.05). Malaria parasitaemia (1+ to 3+) was significantly (p=0.001) associated with bacteriuria. Staphylococcus aureus (30.3%), Escherichia coli (20.4%) and Proteus species (5.3%) were isolated and these isolates were highly susceptible to Gentamicin (GEN), Ciprofloxacin (CIP) and Nitrofurantoin (NIT) but were resistant to ampicillin (AMP). Staphylococcus aureus was the predominant cause of the UTI and the isolates were highly resistant to ampicillin but susceptible to gentamicin, ciprofloxacin and nitrofurantoin.

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Epidemiological basis for clinical diagnosis of childhood malaria in endemic zone in West Africa

Cited by 82 publications

References 6 publications

Usefulness of clinical algorithm as screening process to detected malaria in low-to-moderate transmission areas of scarce health related resources

Usefulness of clinical algorithm as screening process to detected malaria in low-to-moderate transmission areas of scarce health related resources

"Test and treat" or presumptive treatment for malaria in high transmission situations? A reflection on the latest WHO guidelines

Co-existence of malaria and urinary tract infection among children under five: A cross-sectional study of the Assin-South Municipality, Ghana

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