Presumptive Treatment of Malaria in Ghana: Was It Ever Useful? Evidence from the Kassena-Nankana District of Northern Ghana

Abstract

Background The WHO currently advocates parasitological confirmation of malaria before treatment is commenced. However, many arguments have emerged both for and against this new position. To contribute to the debate, this secondary data analysis was conducted to determine the likelihood of malaria parasitaemia in a child presenting with fever, vomiting, or cough in the Kassena-Nankana District. Methods The dataset for this analysis was generated during a study to assess the incidence and risk factors for paediatric rotavirus diarrhoea in the Kassena-Nankana District. Over a two-year period, trained field staff recruited 2086 subjects with episodes of diarrhoea aged 24 months or below into the study. A standard case report form was used to collect data on histories of illness, symptoms, vaccination, and anthropometry. Blood smears were tested for malaria parasites. The data set generated was obtained, cleaned, and analysed using Epi Info version 7.1.1.14 statistical software. Results Of the 2086 subjects recruited, 2078 had blood smears done and 54.0% had malaria parasites. Fever and vomiting appeared to be associated with parasitaemia with odds ratios of 1.9 (95% CI: 1.5586–2.2370) and 1.2 (95% CI: 1.0352–1.4697), respectively. Cough however appeared protective with an odds ratio of 0.8 (95% CI: 0.6910–0.9765). The odds of parasitaemia appeared to increase where a child presented with more than one symptom. Conclusion Nearly half (46%) of the subjects in this study presented with symptoms but had no malaria. Presumptive treatment of malaria may therefore be useful in situations where diagnostic tests are not readily available, its routine practice should however not be encouraged.

Request for Antimalarial Medicines and Their Dispensing Without a Prescription in Community Pharmacies in Rwanda

“…Similarly, in Ghana, fever is the most common symptom that often leads to presumptive treatment. 35 As in the current study, in Ethiopia, continued customer pressure was the major reason for maintaining the counter-sale of antibiotics. 46 Similar to our study, client pressure has been identified as a factor behind dispensing antibiotics among community pharmacists in Sudan.…”

“…2 Treating malaria without prior diagnostic confirmation promotes self-medication, which can lead to antimalarial resistance, a global concern. [34][35][36][37] Thus, this finding illustrates a potential risk of malaria misdiagnosis, which may accelerate the burden of antimalarial drug resistance reported in Rwanda as the first African country. 21 The current finding is yet another demonstration that those community pharmacies facilitate self-medication, which was similarly reported in a study in Rwanda.…”

The Use of Screening Algorithm to Defer Blood Donors with Subclinical Malaria

“…Additionally, donors that did not use insecticide repellents and those that were nocturnally active for a long time as well as those that experienced frequent mosquito bites were associated with subclinical malaria. The factors identified in this study have previously been identified to be associated with clinical malaria [ 19 – 25 ]. These findings were not surprising since all clinical malaria cases begin asymptomatically.…”

Rationalization of the Laboratory Diagnosis for Good Management of Malaria: Lessons from Transitional Methods

“…The hazard of presumptive treatment hence is not just overdiagnosis of malaria, but also confusion and subsequently missed opportunities to correctly treat an ill child. Certain relevant studies [ 6 , 7 ] demonstrated that patients with symptoms similar to malaria in endemic areas should not always be treated as malaria without laboratory confirmation. Presumptive treatment can indirectly accelerate the emergence of parasite resistance [ 8 ] to treatment, resulting in nonmalarial fevers being inappropriately treated with antimalaria drugs, endangering patient life and quality of care.…”