Presumptive treatment of fever cases as malaria: help or hindrance for malaria control?

Gosling, Roly; Drakeley, Christopher J.; Mwita, Alex; Chandramohan, Daniel

doi:10.1186/1475-2875-7-132

Cited by 43 publications

(45 citation statements)

References 15 publications

(19 reference statements)

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“…Despite reported falling transmission in much of sub-Saharan Africa, [1][2][3] malaria remains a leading cause of inpatient admissions and mortality in paediatric wards. [4][5][6] The policy for first-line treatment of severe malaria is a critical factor in determining malaria mortality.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa

Lubell

Riewpaiboon

Dondorp

et al. 2011

Bull. World Health Organ.

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Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa

Lubell

Riewpaiboon

Dondorp

et al. 2011

Bull. World Health Organ.

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“…However, in many malaria-endemic countries, clinical diagnosis is more often the only determining factor for treatment, as laboratory techniques to confirm the clinical suspicion are considered to be expensive, labor-intensive, or not sensitive enough [11]. Fever is the clinical hallmark of uncomplicated malaria [12,13], and empiric treatment of fever with antimalarials is widely advocated and practiced in Africa.…”

Section: Discussionmentioning

confidence: 99%

“…However, the hidden cost of drug resistance associated with inappropriate treatment may be substantial. The major risk of a presumptive treatment strategy is an increase in drug resistance, but a benefit may be a reduction in malaria rates as evident in other parts of Africa [13].…”

Section: Discussionmentioning

confidence: 99%

Low reliability of home-based diagnosis of malaria in a rural community in western Kenya

Kakai

Nasimiyu²,

Odero

2010

J Infect Dev Ctries

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Introduction: Home-based management of malaria is promoted as a major strategy for improving prompt delivery of effective malaria treatment in Africa. This study aimed to determine the proportion of children who tested positive for malaria with routine light microscopy among those whose mothers had made a home-based diagnosis in a rural community in Western Kenya. Methodology: This cross-sectional study was conducted at Bokoli location, Bungoma East District in November and December 2007. Mothers of children five years of age or under with malaria diagnosed by their mothers were interviewed (n = 96). Duplicate blood smears were collected, stained by field stain A (Methylene blue, Azure) and B (Eosin), and examined for malaria parasites using light microscopy. Results: Only 30/96 (31.2%) specimens were positive for Plasmodium falciparum. Elevated temperature (70/96; 72.9%) in their children was the most commonly cited criterion for diagnosis of malaria by the mothers. In 57 of the 96 cases, information was given by the mothers regarding treatment during the current malaria episode; of these, 10 (17.5%) had received treatment for malaria, but six (60%) of these were parasite negative. This means that only 4/21 (19.0%) with positive smear microscopy received treatment. The most common anti-malaria drugs used were Fansidar (37.8%) and Metakelfin (29.7%). Conclusion: The difficulty of diagnosing malaria accurately at home increases the urgent need for improved diagnostic tools that can be used at the community level in poor populations. Intervention measures are needed to increase the treatment rate to reduce reservoirs and malaria parasite transmission.

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“…[5][6][7][8] High transmission, and associated levels of morbidity and mortality For many years, in high-transmission settings malaria was considered to be either the primary cause of all febrile illnesses or a major contributory factor. 7,[9][10][11] Studies from sub-Saharan Africa suggested that asymptomatic parasitaemia in children in high-transmission settings could be as high as 71% in under-five children 12 , and between 37% and 68% in children aged up to ten years of age.…”

Section: Justifications For the Presumptive Diagnosis Of Malariamentioning

confidence: 99%

“…[33][34][35] However, the decision to shift from presumptive to test-based approach in managing malaria has occasioned considerable debate. 6,[36][37][38] Those who favoured the shift to test-based management of malaria argued that the factors that justified the presumptive approach were no longer valid. Malaria transmission, originally high, has been declining and affordable antimalarials were no longer effective and had been replaced with the more expensive artemisinin-based combination therapy (ACT).…”

Section: Arguments For and Against The Shiftmentioning

confidence: 99%

Shifting from Presumptive to Test-Based Management of Malaria - Technical Basis and Implications for Malaria Control in Ghana

Baiden

Malm

Bart-Plange

et al. 2014

Ghana Medical Journal

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SUMMARYThe presumptive approach was the World Health Organisation (WHO) recommended to the management of malaria for many years and this was incorporated into syndromic guidelines such as the Integrated Management of Childhood Illnesses (IMCI). In early 2010 however, WHO issued revised treatment guidelines that call for a shift from the presumptive to the testbased approach. Practically, this implies that in all suspected cases, the diagnosis of uncomplicated malaria should be confirmed using rapid test before treatment is initiated. This revision effectively brings to an end an era of clinical practice that span several years. Its implementation has important implications for the health systems in malaria-endemic countries. On the basis of research in Ghana and other countries, and evidence from program work, the Ghana National Malaria Control Program has issued revised national treatment guidelines that call for implementation of test-based management of malaria in all cases, and across all age groups. This article reviews the evidence and the technical basis for the shift to test-based management and examines the implications for malaria control in Ghana.

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Presumptive treatment of fever cases as malaria: help or hindrance for malaria control?

Cited by 43 publications

References 15 publications

Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa

Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa

Low reliability of home-based diagnosis of malaria in a rural community in western Kenya

Shifting from Presumptive to Test-Based Management of Malaria - Technical Basis and Implications for Malaria Control in Ghana

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