Predictors of malaria in febrile children in Sokoto, Nigeria

Abstract

Background:Presumptive diagnosis of malaria is widespread, even where microscopy is available. As fever is very nonspecific, this often leads to over diagnosis, drug wastage and loss of opportunity to consider alternative causes of fever, hence the need to improve on the clinical diagnosis of malaria.Materials and Methods:In a prospective cross-sectional comparative study, we examined 45 potential predictors of uncomplicated malaria in 800 febrile children (0-12 years) in Sokoto, Nigeria. We developed a clinical algorithm for malaria diagnosis and compared it with a validated algorithm, Olaleye's model.Results:Malaria was confirmed in 445 (56%). In univariate analysis, 13 clinical variables were associated with malaria. In multivariate analysis, vomiting (odds ratio, OR 2.6), temperature ≥ 38.5°C (OR 2.2), myalgia (OR 1.8), weakness (OR 1.9), throat pain (OR 1.8) and absence of lung crepitations (OR 5.6) were independently associated with malaria. In children over age 3 years, any 3 predictors had a sensitivity of 82% and specificity of 47% for malaria. An Olaleye score ≥ 5 had a sensitivity of 62% and a specificity of 51%.Conclusion:In hyperendemic areas, the sensitivity of our algorithm may permit presumptive diagnosis of malaria in children. Algorithm positive cases can be presumptively treated, and negative cases can undergo parasitological testing to determine need for treatment.

Analysis of Plasmodium falciparum Pfcrt and Pfmdr1 genes in parasite isolates from asymptomatic individuals in Southeast Nigeria 11 years after withdrawal of chloroquine

“…The prevalence of asymptomatic malaria in Nigeria has been reported to range from 25% [18] to 59% [19, 20] in some regions of the country. Asymptomatic infection is an important obstacle in malaria control since such asymptomatic carriers do not seek treatment and thereby remain reservoirs for the life cycle of the infection to continue.…”

Prevalence and Clinical Forms of Malaria Among Febrile Hiv-Infected Children Seen at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

“…This may mean that fever is a possible sensitive clinical case definition for malaria. Singh in Sokoto also reported a lower prevalence of 56% (Singh et al, 2014) during the dry season which corresponded to period of low malaria transmission.…”

Overtreatment of malaria in the Nigerian healthcare setting; prescription practice, rationale and consequences

“…A study conducted in southeastern Nigeria found that 86% of caregivers diagnosed malaria mainly by noticing fever, headache, cough, and pains [ 16 ]. A study in Sokoto State examined 800 febrile children who were presumed to have malaria and found that only 56% had confirmed malaria while the remaining 44% were misdiagnosed and treated for malaria [ 17 ]. In Borno State, 310 febrile patients were tested and only 1% were positive for malaria.…”