The impact of delayed treatment of uncomplicated P. falciparum malaria on progression to severe malaria: A systematic review and a pooled multicentre individual-patient meta-analysis

Mousa, Andria; Al-Taiar, Abdullah; Anstey, Nicholas M.; Badaut, Cyril; Barber, Bridget E.; Bassat, Quique; Challenger, Joseph D.; Cunnington, Aubrey J.; Datta, Dibyadyuti; Drakeley, Chris; Ghani, Azra C; Gordeuk, Victor R.; Grigg, Matthew J.; Hugo, Pierre; John, Chandy C.; Mayor, Alfredo; Migot-Nabias, Florence; Opoka, Robert O.; Pasvol, Geoffrey; Rees, Claire; Reyburn, Hugh; Riley, Eleanor M.; Shah, Binal N.; Sitoe, António; Sutherland, Colin J.; Thuma, Philip E.; Unger, Stefan; Viwami, Firmine; Walther, Michael; Whitty, Christopher J. M.; William, Timothy; Okell, Lucy

doi:10.1371/journal.pmed.1003359

Cited by 66 publications

(68 citation statements)

References 71 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Severe symptoms and the choice or referral to attend primary, secondary or tertiary health care may confound these results. Evidence from clinical studies may reflect this, showing longer delays to treatment than reported here [ 9 , 21 - 23 ]. A more robust assessment of the impact of introducing CHWs on treatment delays would include a comparison of delays in a location before and after deployment of CHWs.…”

Section: Discussionmentioning

confidence: 64%

“…Whilst we can assess evidence of coverage, access and equity outcomes, we do not evaluate the quality of care or downstream health outcomes which are beyond the scope of this analysis. Improved access and reduced delays should lead to improved health outcomes [ 9 , 21 , 23 ] although confounding factors such as quality of care, referral efficiency, treatment seeking behaviour and public/private preferences are also important.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Does integrated community case management (iCCM) target health inequities and treatment delays? Evidence from an analysis of Demographic and Health Surveys data from 21 countries in the period 2010 to 2018

Winskill

Mousa

Oresanya³

et al. 2021

J Glob Health

Self Cite

View full text Add to dashboard Cite

Background Integrated community case management (iCCM) is a programme that can, via community health workers (CHWs), increase access to timely and essential treatments for children. As well as improving treatment coverage, iCCM has an additional equity-focus with the aim of targeting underserved populations. To assess the success of iCCM programmes it is important that we understand the contribution they are making to equitable health coverage. Methods We analysed demographic and health survey data from 21 countries over 9 years to assess evidence and evaluate iCCM programmes. We summarise the contribution CHWs are making relative to other health care provider groups and what treatment combinations CHWs are commonly prescribing. We assessed the ability of CHWs to target treatment delays and health inequities by evaluating time to treatment following fever onset and relationships between CHWs and wealth, rurality and remoteness. Results There was good evidence that CHWs are being successfully targeted to improve inequities in health care coverage. There is a larger contribution of CHWs in areas with higher poverty, rurality and remoteness. In six surveys CHWs were associated with significantly shorter average time between fever onset and advice or treatment seeking, whilst in one they were associated with significantly longer times. In areas with active CHW programmes, the contribution of CHWs relative to other health care provider groups varied between 11% to 45% of treatment visits. The distribution of types of treatment provided by CHWs was also very variable between countries. Conclusions The success of an iCCM programme depends not only on increasing treatment coverage but addressing inequities in access to timely health care. Whilst much work is still needed to attain universal health care targets, and despite incomplete data, there is evidence that iCCM is successfully addressing treatment delays and targeting underserved populations.

show abstract

Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Does integrated community case management (iCCM) target health inequities and treatment delays? Evidence from an analysis of Demographic and Health Surveys data from 21 countries in the period 2010 to 2018

Winskill

Mousa

Oresanya³

et al. 2021

J Glob Health

Self Cite

View full text Add to dashboard Cite

show abstract

“…Doctors could deduce the pathogens for patients judged by where they came from, without hours waiting for laboratory testing results for pathogens, giving the possibility of rapid access for treatment. A review con rmed that rapid access for treatment reduced risk of severe disease 24,25 . From our study, most cases came from Democratic Republic of the Congo(DRC), patients from DRC infected by almost all kinds of plasmodium.…”

Section: Clinical Implications For Geographical and Pathogens Distributionsmentioning

confidence: 99%

Factors Associated with Prolonged Hospital Stay: a Retrospective Study for Imported Malaria Cases

Liang

Jin

Zhang

et al. 2021

Preprint

View full text Add to dashboard Cite

Background China had entered post-elimination era for malaria, however, the imported cases are continuously are a public health concern as the increasing number of cases. In this study we studied the potential predictive factors for prolonged hospital stay for imported malaria patients. Material and Methods We retrospectively collected patients of imported malaria cases data from 2017–2020 in our hospital. we analyzed the data from clinical, epidemiological, geographical, and seasonal points of view, and used cox proportional hazard model to find the predictive factors for prolonged hospital stay. Results We found most of imported cases were from Democratic Republic of the Congo(23%, 34/150) and most cases 74%(26/34) were infected by P. falciparum. Through Edwards Test, no significant seasonality of imported cases were found(χ2 = 2.51 p-value = 0.28). We found bacterial infection(HR = 0.58, p-value = 0.01) and thrombocytopenia(HR = 0.66, p-value = 0.02) were protective factors for discharge, that were, the risk factors for prolonged hospital stay. Conclusions The imported cases are the major risk of malaria in post-elimination era of China. The bacterial infection and thrombocytopenia were the risk factors for prolonged hospital stay.

show abstract

“…The WHO recommends that treatment for malaria should occur within 24 hours of the onset of malaria symptoms to prevent the advancement of infection [2,5,11]. A recent systematic review on the impact of delaying in seeking malaria treatment indicates that the risk of severe malaria for patients seeking care more than 24 hours was higher than those seeking care less than 24 hours (odds ratio : 1.33, 95% CI: 1.07-1.64) [12]. Moreover, studies on various settings among Asia communities indicated that patients sought care for malaria at health facilities on average at least two days after the onset of symptoms [13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Malaria treatment-seeking behaviour and its associated factors: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia

Guntur

Kingsley

Islam

2021

Preprint

View full text Add to dashboard Cite

Introduction. The World Health Organization recommends seeking medical treatment within 24 hours after transmission of malaria to reduce the risk of severe complications and its onwards spread. However, in some parts of Indonesia, including East Nusa Tenggara Province (ENTP), this adherence is not achieved for a range of reasons including delays in visiting health centres. This study aims to determine factors related to the poor understanding of appropriate malaria treatment–seeking behaviour (AMTSB) of rural adults in ENTP. AMTSB was defined as seeking treatment at professional health facilities within 24 hours of the onset of malaria symptoms. Methods. A cross–sectional study was conducted in the East Sumba, Belu, and East Manggarai district of ENTP between October and December 2019. A multi–stage cluster sampling procedure was applied to enrol 1495 participants aged between 18 and 89 years old. Data were collected through face–to–face interview. Multivariable logistic regression analyses were used to assess significant factors associated with the poor understanding of AMTSB. Results. 86% of participants were found to be familiar with the term malaria. However, poor understanding level of AMTSB in rural adults of ENTP achieved 60.4% with a 95% confidence interval (CI): 56.9 — 63.8. The most important factors associated with the poor understanding were lower levels of education, low socio–economic status (SES), occupation, and distance to the nearest health facilities. The poor understanding of AMTSB was significantly higher for adults with no education (adjusted odds ratio (AOR) 3.42, 95% CI: 1.81, 6.48); having low SES (AOR: 1.87, 95% CI: 1.19, 2.96); residing three km away from the nearest health facilities (AOR: 1.73, 95% CI: 1.2, 2.5); and working as housewife (AOR: 1.63, 95%CI: 1.01 — 2.63). Ethnicity, and family size were not associated with the poor understanding of AMTSB. Conclusion. The proportion of rural adults having a poor understanding of AMTSB was high leading to ineffective implementation of artemisinin&ndash]based combination therapies as the method to treat malaria in ENTP. Improving awareness of AMTSB for rural adults having low-level education, low SES, working as a housewife, and living three km from the nearest health facilities is critical to support the efficacy of malaria treatment in ENTP, as well as to advance the Indonesian government′s objective to achieve malaria elimination by 2030.

show abstract

The impact of delayed treatment of uncomplicated P. falciparum malaria on progression to severe malaria: A systematic review and a pooled multicentre individual-patient meta-analysis

Abstract: The impact of delayed treatment of uncomplicated P. falciparum malaria on progression to severe malaria: A systematic review and a pooled multicentre individual-patient meta-analysis. PLoS Med 17(10): e1003359.

Cited by 66 publications

References 71 publications

Does integrated community case management (iCCM) target health inequities and treatment delays? Evidence from an analysis of Demographic and Health Surveys data from 21 countries in the period 2010 to 2018

Does integrated community case management (iCCM) target health inequities and treatment delays? Evidence from an analysis of Demographic and Health Surveys data from 21 countries in the period 2010 to 2018

Factors Associated with Prolonged Hospital Stay: a Retrospective Study for Imported Malaria Cases

Malaria treatment-seeking behaviour and its associated factors: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia

Contact Info

Product

Resources

About