Abstract
Background. Malaria diagnosis has been largely done clinically. The implication is the likely overdiagnosis of malaria when diagnosis is done soley on the basis of symptoms. Methods. Parasitological diagnosis was done among 1211, 0–12 years old febrile children that attended a Primary Health Centre in Lagos, Nigeria, who were diagnosed clinically and treated based on symptoms. Results. A total of 251 of 1,211 (20.7%) children less than 12 years old and 174 of the 1,027 of children 0–≤5 yrs (16.9%) were slide positive while 853 (83.1%) of 0–≤5 yrs that were slide negative were treated with Artemisinin based combination therapies (ACTs) in line with the Integrated Management of Childhood Infectioins (IMCI) guidelines and standard practice of the Clinic. Chills, diarrhoea, convulsions, headache, cough, respiratory distress, inactivity, loss of apetite, and vomiting occured significantly in the 0–≤5 and >5–12 years old malaria negative children. Conclusions. Overdiagnosis and overtreatment of malaria in this study was high. Therefore, malaria medicines should be prescribed on the basis of parasitological confirmation of all suspected malaria cases. The availability of quality-assured malaria rapid diagnostic tests (RDTs) is a useful tool to confirm malaria cases while the cause of the non-malaria fevers can be followed up and managed appropriately.
Highlights
In areas of intense malaria transmission, such as large parts of tropical Africa, where the burden of malaria is greatest and where severe disease and mortality are largely con ned to children under 5 years of age, malaria treatment is o en dispensed on the basis of “fever” and other malariaassociated symptoms such as chills, headache, vomiting, respiratory distress and so forth, rather than on the basis of a parasitologically con rmed diagnosis. is is mainly due to the wholesale implementation of the Integrated Management of Childhood Illness guidelines [1]
E clinical presentation of malaria is highly variable and overlaps with that of a number of other common illnesses, including pneumonia, which are associated with signi cant morbidity and mortality [2,3,4]. e policy of presumptive treatment of malaria for all febrile illnesses has been widely advocated in sub-Saharan Africa, especially in young children [5, 6]
All the children that participated were treated according to the standard routine care of the health facility and this was based on the Integrated Management of Childhood Infectioins (IMCI) guidelines. e results of the malaria microscopy tests were made available to the management of the health facility as a basis for the review of their standard malaria case-management protocol
Summary
In areas of intense malaria transmission, such as large parts of tropical Africa, where the burden of malaria is greatest and where severe disease and mortality are largely con ned to children under 5 years of age, malaria treatment is o en dispensed on the basis of “fever” and other malariaassociated symptoms such as chills, headache, vomiting, respiratory distress and so forth, rather than on the basis of a parasitologically con rmed diagnosis. is is mainly due to the wholesale implementation of the Integrated Management of Childhood Illness guidelines [1]. Presumptive management of fevers and/or other suspected symptoms of malaria as malaria results in signi cant. Parasitological diagnosis was done among 1211, 0–12 years old febrile children that attended a Primary Health Centre in Lagos, Nigeria, who were diagnosed clinically and treated based on symptoms. A total of 251 of 1,211 (20.7%) children less than 12 years old and 174 of the 1,027 of children 0–≤5 yrs (16.9%) were slide positive while 853 (83.1%) of 0–≤5 yrs that were slide negative were treated with Artemisinin based combination therapies (ACTs) in line with the Integrated Management of Childhood Infectioins (IMCI) guidelines and standard practice of the Clinic. Overdiagnosis and overtreatment of malaria in this study was high. erefore, malaria medicines should be prescribed on the basis of parasitological con rmation of all suspected malaria cases. e availability of uality-assured malaria rapid diagnostic tests (RDTs) is a useful tool to con rm malaria cases while the cause of the non-malaria fevers can be followed up and managed appropriately
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