Consequences of restricting antimalarial drugs to rapid diagnostic test‐positive febrile children in south‐west Nigeria

Abstract

Objectives To investigate the consequence of restricting antimalarial treatment to febrile children that test positive to a malaria rapid diagnostic test (MRDT) only in an area of intense malaria transmission. Methods Febrile children aged 3–59 months were screened with an MRDT at health facilities in south‐west Nigeria. MRDT‐positive children received artesunate–amodiaquine (ASAQ), while MRDT‐negative children were treated based on the clinical diagnosis of non‐malaria febrile illness. The primary endpoint was the risk of developing microscopy‐positive malaria within 28 days post‐treatment. Results 309 (60.5%) of 511 children were MRDT‐positive while 202 (39.5%) were MRDT‐negative at enrolment. 18.5% (50/275) of MRDT‐positive children and 7.6% (14/184) of MRDT‐negative children developed microscopy‐positive malaria by day 28 post‐treatment (ρ = 0.001). The risk of developing clinical malaria by day 28 post‐treatment was higher among the MRDT‐positive group than the MRDT‐negative group (adjusted OR 2.74; 95% CI, 1.4, 5.4). A higher proportion of children who were MRDT‐positive at enrolment were anaemic on day 28 compared with the MRDT‐negative group (12.6% vs. 3.1%; ρ = 0.001). Children in the MRDT‐negative group made more unscheduled visits because of febrile illness than those in MRDT‐positive group (23.2% vs. 12.0%; ρ = 0.001). Conclusion Restricting ACT treatment to MRDT‐positive febrile children only did not result in significant adverse outcomes. However, the risk of re‐infection within 28 days was significantly higher among MRDT‐positive children despite ASAQ treatment. A longer‐acting ACT may be needed as the first‐line drug of choice for treating uncomplicated malaria in high‐transmission settings to prevent frequent re‐infections.

SD-Bioline Malaria Rapid Diagnostic Test Performance and Time to Become Negative After Treatment of Malaria Infection in Southwest Nigerian Children

“…The study reported here is part of a larger study which evaluated the consequences of restricting ACT treatment to only MRDT-positive under-five children. [ 17 ] Enrollment into the study was carried out between middle November 2013 and middle of November 2014.…”

The need for social group interventions to increase malaria rapid diagnostic test uptake in Nigeria

“…3,4 The benefits of using MRDTs have also been specifically validated among the most vulnerable population (febrile children younger than 5 years). 5 However, the potential of MRDTs will not be fully realised if uptake remains low. Improving the uptake of MRDTs is particularly important during the COVID-19 pandemic because the early symptoms of COVID-19 are similar to those of malaria and other febrile illness, with many patients with COVID-19 being diagnosed with malaria by default.…”

Age-Dependent Prevalence of Malaria in Akeddei Community in South-South Nigeria

“…However, most fever cases are considered as malaria infections. They are treated as such without parasitological confirmation among all age groups in rural communities in sub-Saharan Africa [10], especially in Nigeria which carries a disproportionate burden of the infection [11,12]. The overuse or inappropriate use of antimalarial medications is on the increase in Nigeria.…”