Usefulness of clinical case-definitions in guiding therapy for African children with malaria or pneumonia

Redd, Stephen C.; Bloland, Peter B.; Kazembe, Peter N.; Patrick, Ellen; Tembenu, R; Campbell, C. C.

doi:10.1016/0140-6736(92)93160-o

Cited by 67 publications

(45 citation statements)

References 16 publications

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“…clinical signs, symptoms, or other variables that could help clinicians more precisely discriminate at the hospital level between those two diseases. Previous studies addressing this question at the outpatient level have produced disappointing results, 10,12,13,33 and hospital-based studies 15,34,35 with more complex differentiating techniques, such as microbiology, laboratory biomarkers, pulse oximetry, or radiography, have shown better results at producing models, but still with limited practicality for the medical personnel faced with such complex patients.…”

Section: Discussionmentioning

confidence: 99%

“…Although at the peripheral level these highly sensitive clinical algorithms have contributed to saving thousands of lives, 6 their poor specificity makes them insufficiently reliable at the hospital level unless complemented by laboratory determinations. [7][8][9] There has been extensive reporting of the overlap in clinical presentation between malaria and ARI, both at the outpatient level [10][11][12][13][14] and among children admitted to hospitals. 15 The importance of this overlap will depend upon the epidemiology of both conditions in each particular setting, but also the severity of the presentation and the age of the patient.…”

Section: Introductionmentioning

confidence: 99%

“…In this specific subgroup of admitted patients, precise etiologic diagnosis without laboratory support is problematic. [10][11][12][13][14][15] Diagnostic uncertainty often leads to overtreatment, wasting the limited existing resources and accelerating antibiotic/antimalarial drug resistance levels in the community, but more importantly, misdiagnosis may divert the specific treatment from the real etiology, putting in dan ger the patient's life. Because the quality of care and services in many referral hospitals in Africa is already notoriously poor and necessarily constrained by limited resources, 16,17 distinguishing the real etiology causing their admission becomes critical to improve patient's survival chances.…”

Section: Introductionmentioning

confidence: 99%

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Distinguishing Malaria from Severe Pneumonia among Hospitalized Children who Fulfilled Integrated Management of Childhood Illness Criteria for Both Diseases: A Hospital-Based Study in Mozambique

Bassat¹,

Machevo²,

O’Callaghan-Gordo³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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Abstract. Malaria and severe pneumonia in hospitalized young children may show striking clinical similarities, making differential diagnosis challenging. We investigated ways to increase diagnostic accuracy in patients hospitalized with clinical symptoms compatible with malaria and severe pneumonia, in an area with high a prevalence of infection with human immunodeficiency virus. A total of 646 children admitted at the Manhiça District Hospital in Manhiça, Mozambique who met the World Health Organization clinical criteria for severe pneumonia and malaria were recruited for 12 months and thoroughly investigated to ascertain an accurate diagnosis. Although symptom overlap between malaria and severe pneumonia was frequent among hospitalized children, true disease overlap was uncommon. Clinical presentation and laboratory determinations were ineffective in reliably distinguishing between the two diseases. Infection with human immunodeficiency virus differentially influenced the epidemiology and clinical presentation of these two infectious diseases, further challenging their discrimination on clinical grounds, and having a greater impact on the current burden and prognosis of severe pneumonia. Malaria and pneumonia in the study area. At the time of the study, malaria in Manhiça accounted for one-third of all outpatient visits, 19 half of the pediatric admissions, and 19% of all in-hospital pediatric deaths. 22 A total of 11.1% of all malaria admissions and 41.1% of severe malaria cases had severe respiratory findings. 22 Severe pneumonia accounted for 16% of hospitalizations among children less than two years of age, and had an associated case-fatality rate (CFR) of 11%. 23 Verbal autopsy studies confirmed from the community perspective that these two conditions are the leading causes of death in children less than five years of age. 24Procedures for recruited children and sample collection. This study was part of a larger project designed to describe the epidemiology and clinical characteristics of children less than five years of age admitted with respiratory distress. However, this analysis includes only patients simultaneously fulfilling at admission IMCI-defined clinical criteria for malaria (fever or a history of fever in the preceding 24 hours) and severe pneumonia (cough and/or breathing difficulties, plus chest indrawing with or without increased respiratory rate according to age group). Children fulfilling inclusion criteria and whose parents had signed an informed consent form underwent a series of standardized procedures. Anteroposterior chest radiographs were obtained on admission or otherwise within the first 48 hours of hospitalization according to severity. Pulse oximetry (Nellcor, Boulder, CO) was used to determine oxygen saturation, and nasopharyngeal aspirates were performed for diagnosis of respiratory viruses by using NPAK ® Kits (MPRO, Farmington Hills, MI). Venous blood was obtained at admission for malaria diagnosis, blood culture, full blood cell count, and biochemical determinations.HIV-spe...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Distinguishing Malaria from Severe Pneumonia among Hospitalized Children who Fulfilled Integrated Management of Childhood Illness Criteria for Both Diseases: A Hospital-Based Study in Mozambique

Bassat¹,

Machevo²,

O’Callaghan-Gordo³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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“…Most importantly, the delays in the etiological diagnosis of non-malarial fevers can have serious consequences on the patient (Amexo et al, 2004;Barnish et al, 2004;Nankabirwa et al, 2009). Many other diseases such as typhoid fever, pneumonia, toxoplasmosis, rubella and other bacteraemia are very often misdiagnosed for malaria because of their very similar clinical manifestations, making their differentiation difficult (Redd et al, 1992;Prasad et al, 2015). With reports of the decline in the incidence of malaria in many African countries (Bouyou-Akotet et al, 2009;Delacollette et al, 2009;Satoguina et al, 2009), it is imperative that parasite confirmation of malaria be scaled up in all age groups.…”

Section: Introductionmentioning

confidence: 99%

The assessment of fever in under-five children in the Ekounou Health Area of Yaounde, Cameroon: Usefulness of rapid diagnostic tests

Tiedeu¹,

Tadjouo²,

Sontsa³

et al. 2017

Int. J. Med. Med. Sci.

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Improper diagnosis and management of febrile patients results in the persistence of malaria and other conditions with similar symptoms. The algorithm established here with Rapid Diagnostic Tests (RDTs) will help in the follow-up and treatment of fever patients according to the guidelines on Integrated Management of Childhood Illness (IMCI). This study aimed at determining the causes of fever in children and at valorizing the use of RDTs for the diagnosis of febrile diseases. Fifty children with fever, aged between 0 and 5 years, were recruited in a cross-sectional study at the Ekounou Baptist Clinic in Yaounde. RDTs were used to assess for the four common causes of febrile illness in the area. Microscopy was done and the Plasmodium species were confirmed by nested Polymerase Chain Reaction (PCR). Of the 50 febrile children, none was rubella seropositive, while 8% had malaria, 22% had toxoplasmosis infection, 8% had Salmonella typhi, 14% had a malaria-typhoid fever co-infection, 4% had a malaria-toxoplasmosis co-infection, 6% had a malaria-toxoplasmosis-typhoid fever coinfection, and 38% were negative for all the suspected common causes of fever in the health district. The overall frequencies of occurrence attributed 32% to malaria, 32% to toxoplasmosis and 28% to typhoid fever. Among all the positive malaria cases (n=16 (32%)) Plasmodium falciparum, Plasmodium malariae and Plasmodium ovale were identified by nested PCR. Malaria RDT results agreed significantly with the microscopy (kappa=0.81; p<0.0001) and PCR (kappa=0.84; p<0.0001) results; and the microscopy results also concurred significantly with the PCR results (kappa=0.77; p<0.0001). Malaria was not the exclusive cause of fever. Toxoplasmosis was found to occur in the same proportion as malaria (32%) in the study population. S. typhi was the third most important infection. Therefore RDTs are appropriate tools for the management of childhood febrile diseases.

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“…Descriptive studies of children and adults with fever and high parasitemia have indicated that, in addition to headaches, myalgia, and vomiting, other symptoms include diarrhea, cough, and rapid breathing. Malaria disease has a very similar clinical presentation to other infections, making it hard to differentiate from conditions such as typhoid, pneumonia, and bacteremia (2,105,(116)(117)(118).…”

Section: Defining Malaria Fevers In Clinical Practicementioning

confidence: 99%

Therapy of Falciparum Malaria in Sub-Saharan Africa: from Molecule to Policy

et al. 2004

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The burden of falciparum malaria remains as great as ever, and, as has probably always been the case, it is carried mainly by tropical Africa. Of the various means available for the control of malaria, the use of effective drugs remains the most important and is likely to remain so for a considerable time to come. Unfortunately, the extensive development of resistance by the parasite threatens the utility of most of the affordable classes of drug: the development of novel antimalarials has never been more urgently needed. Any attempt to understand the vast complexities of falciparum malaria in Africa requires an ability to think “from molecule to policy.” In consequence, the review ambitiously tries to examine the current pharmacopeia, the process by which new drugs are developed and the ways in which drugs are actually used, in both the formal and informal health sectors. The informal sector is particularly important in Africa, where around half of all antimalarial treatments are bought from informal outlets and taken at home without supervision by health care professionals: the potential impact of adherence on clinical outcome is discussed. Given that the full costs are carried by the patient in a large proportion of cases, the importance of drug affordability is explored. The review also discusses the splicing of new drugs into national policy. The various parameters that feed into deliberations on changes in drug policy are discussed

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Usefulness of clinical case-definitions in guiding therapy for African children with malaria or pneumonia

Cited by 67 publications

References 16 publications

Distinguishing Malaria from Severe Pneumonia among Hospitalized Children who Fulfilled Integrated Management of Childhood Illness Criteria for Both Diseases: A Hospital-Based Study in Mozambique

Distinguishing Malaria from Severe Pneumonia among Hospitalized Children who Fulfilled Integrated Management of Childhood Illness Criteria for Both Diseases: A Hospital-Based Study in Mozambique

The assessment of fever in under-five children in the Ekounou Health Area of Yaounde, Cameroon: Usefulness of rapid diagnostic tests

Therapy of Falciparum Malaria in Sub-Saharan Africa: from Molecule to Policy

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