Abstract
Background: Presumptive and test-based are the two main approaches for management and treatment of Malaria. The presumptive approach relies solely on clinical signs and symptoms to establish diagnosis while the test-based approach depends on laboratory investigation and confirmation. This study compared the use of rapid diagnostic test kit of fever to diagnose and manage Malaria during pre-rainy season (PRE-RS) and post-rainy season (POST-RS). Methods: This was a cross-sectional comparative study in children less than five years carried out in June (PRE-RS) and November 2015 (POST-RS). The children were screened using Malaria rapid diagnostic test (RDT) during the PRE-RS and POST-RS respectively. Parents/guardians of the children were interviewed using a questionnaire. History of fever was determined if the parent/guardian admits the body of the child was hot within the past one week. The degree of association between RDT and history of fever was determined using Odds ratio (OR), and a measure of the degree of agreement between RDT usage and history of fever was determined using Kappa statistics. A p-value less than 0.05 was considered statistically significant. Results: Overall, 1915 children were screened in the PRE-RS and 1697 in the POSTRS survey. In the PRE-RS survey, 217 children (11.3%) were positive for Malaria as determined by RDT while in the POST-RS survey 676 (39.8%) were positive. The history of fever within one week before the survey was 768 (40.1%) in PRERS and 966 (56.9%) in POST-RS survey. Using RDT was 2.18 times and 2.92 times more effective in detecting Malaria as compared to history of fever in PRE-RS and POST-RS (OR=2.18 (95% CI=1.64-2.90)) and (OR=2.92 (95% CI=2.37-3.59)) respectively. Agreement between RDT and history of fever usage was poor (kappa index=0.0912) during PRE-RS and slight (kappa index=0.2343) during POST-RS. Conclusion: Using RDT to detect Malaria infection is more effective than relying on the history of fever. RDT use is also more effective in the POST-RS than PRE-RS. However, further studies are required to determine the cost effectiveness analysis of RDT use in both PRE-RS and POST-RS.
Highlights
It has become clear that the continuous presumptive treatment of Malaria could lead to drug wastage the need for confirmation of cases by microscopy or rapid diagnostic test kits (RDT) prior to treatment [1]
History of fever recorded was low during the post-rainy season (POST-RS)
Using RDT to detect Malaria infection is more effective than history of fever in both pre-rainy season (PRE-RS) and POST-RS
Summary
The World Health Organization (WHO) Malaria report in 2015 indicated profound changes in the incidence of Malaria since the beginning of the millennium [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22]. In 2000, it was estimated that there were 262 million cases of Malaria globally, leading to 839,000 deaths. The two main approaches to the diagnosis of Malaria are the presumptive and test-based approaches. It has become clear that the continuous presumptive treatment of Malaria could lead to drug wastage the need for confirmation of cases by microscopy or rapid diagnostic test kits (RDT) prior to treatment [1]. It is necessary to investigate further whether presumptive fever cases and RDT could be used as diagnostic tools to manage and treat Malaria. Presumptive and test-based are the two main approaches for management and treatment of Malaria. The presumptive approach relies solely on clinical signs and symptoms to establish diagnosis while the test-based approach depends on laboratory investigation and confirmation. This study compared the use of rapid diagnostic test kit of fever to diagnose and manage Malaria during pre-rainy season (PRE-RS) and post-rainy season (POST-RS)
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