Challenges Diagnosing and Treating Acute Febrile Children with Suspected Malaria at Healthcare Facilities in the Mwanza Region, Tanzania

Abstract

Background Acute febrile diseases transmitted by mosquitos are a diagnostic challenge for pediatricians working Sub-Sahara-Africa. Misclassification due to the lack of rapid, reliable diagnostic tests leads to the overuse of antibiotics and antimalarials. Methods Between April 2016 and March 2018, 751 children presenting with acute fever and suspected of having malaria were examined at healthcare facilities located in Mwanza Region, Tanzania. Sociodemographic data and medical histories were obtained. The sensitivity and specificity of blood smear microscopy and malaria rapid diagnostic tests were compared to multiplex-RT-PCR-ELISA. Results One hundred thirty-seven of 698 (19.6%) pediatric patients meeting the inclusion criteria and presenting with acute fever had Plasmodium falciparum infections confirmed by PCR. 22,8% received antibiotics and 22,6% antimalarials prior to admission. No evidence of arboviral infections was found. Blood smear microscopy exhibited 33.3% sensitivity and 93.2% specificity. Malaria Rapid Test NADAL® provided 86.6% sensitivity and 98.2% specificity in detecting acute malaria infections. Only 7.2% of malaria-negative children received antimalarials at Sengerema Designated District Hospital when treatment was guided by the results of the rapid test. Conclusions Misclassification and premedication of non-malarial, febrile illnesses contribute to the emergence of antimalarial and antimicrobial resistance. Rapid, reliable diagnostic tests could reduce the number of antimalarial prescription significantly. This occurred when Malaria Rapid Tests were incorporated into the clinical routine and the results were translated into adequate treatment.