Can treatment of malaria be restricted to parasitologically confirmed malaria? A school-based study in Benin in children with and without fever

Jean-François Faucher,Sandrine Houzé,Michel Cot,Pascal Houzé,Philippe Deloron,Todoégnon Béhéton,Patrick Makoutode,Grace Abiou,Edgard Ouendo

doi:10.1186/1475-2875-9-104

Abstract

BackgroundApplying the switch from presumptive treatment of malaria to new policies of anti-malarial prescriptions restricted to parasitologically-confirmed cases is a still unsolved challenge. Pragmatic studies can provide data on consequences of such a switch. In order to assess whether restricting anti-malarials to rapid diagnostic test (RDT)-confirmed cases in children of between five and 15 years of age is consistent with an adequate management of fevers, a school-based study was performed in Allada, Benin.MethodsChildren in the index group (with fever and a negative RDT) and the matched control group (without fever and a negative RDT) were not prescribed anti-malarials and actively followed-up during 14 days. Blood smears were collected at each assessment. Self-medication with chloroquine and quinine was assessed with blood spots. Malaria attacks during the follow-up were defined by persistent or recurrent fever concomitant to a positive malaria test.Results484 children were followed-up (242 in each group). At day 3, fever had disappeared in 94% of children from the index group. The incidence of malaria was similar (five cases in the index group and seven cases in the control group) between groups. Self-medication with chloroquine and quinine in this cohort was uncommon.ConclusionsApplying a policy of restricting anti-malarials to RDT-confirmed cases is consistent with an adequate management of fevers in this population. Further studies on the management of fever in younger children are of upmost importance.

Highlights

Applying the switch from presumptive treatment of malaria to new policies of anti-malarial prescriptions restricted to parasitologically-confirmed cases is a still unsolved challenge
Restricting anti-malarials to parasitologically-confirmed cases has been recommended in many countries only for children of five years of age or above; this discrepancy between age groups in terms of guidelines [1] on the management of fevers raises questions on the rationale of this strategy [11,12]: if such a management of uncomplicated fevers is reliable, why is it not applied to small children?
The objective of the study was to assess whether applying the algorithm of management of fevers in the school setting is consistent with adequate management of fevers, in the way it does not lead to a high number of undiagnosed malaria attacks, and by comparing the incidence of malaria attacks between the two groups

Summary

Introduction

Applying the switch from presumptive treatment of malaria to new policies of anti-malarial prescriptions restricted to parasitologically-confirmed cases is a still unsolved challenge. In order to assess whether restricting anti-malarials to rapid diagnostic test (RDT)confirmed cases in children of between five and 15 years of age is consistent with an adequate management of fevers, a school-based study was performed in Allada, Benin. Malaria rapid diagnostic tests (RDTs) have been adopted as public heath policy in several African countries, but Restricting anti-malarials to parasitologically-confirmed cases has been recommended in many countries only for children of five years of age or above (provided these children are less at risk for severe malaria); this discrepancy between age groups in terms of guidelines [1] on the management of fevers raises questions on the rationale of this strategy [11,12]: if such a management of uncomplicated fevers is reliable, why is it not applied to small children?.

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