Presumptive Treatment of Malaria in Ghana: Was It Ever Useful? Evidence from the Kassena-Nankana District of Northern Ghana.

Michael N K Babayara,Bright Addo

doi:10.1155/2018/3408089

Michael N K Babayara, Bright Addo

Open Access

https://doi.org/10.1155/2018/3408089

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Abstract

Background The WHO currently advocates parasitological confirmation of malaria before treatment is commenced. However, many arguments have emerged both for and against this new position. To contribute to the debate, this secondary data analysis was conducted to determine the likelihood of malaria parasitaemia in a child presenting with fever, vomiting, or cough in the Kassena-Nankana District. Methods The dataset for this analysis was generated during a study to assess the incidence and risk factors for paediatric rotavirus diarrhoea in the Kassena-Nankana District. Over a two-year period, trained field staff recruited 2086 subjects with episodes of diarrhoea aged 24 months or below into the study. A standard case report form was used to collect data on histories of illness, symptoms, vaccination, and anthropometry. Blood smears were tested for malaria parasites. The data set generated was obtained, cleaned, and analysed using Epi Info version 7.1.1.14 statistical software. Results Of the 2086 subjects recruited, 2078 had blood smears done and 54.0% had malaria parasites. Fever and vomiting appeared to be associated with parasitaemia with odds ratios of 1.9 (95% CI: 1.5586–2.2370) and 1.2 (95% CI: 1.0352–1.4697), respectively. Cough however appeared protective with an odds ratio of 0.8 (95% CI: 0.6910–0.9765). The odds of parasitaemia appeared to increase where a child presented with more than one symptom. Conclusion Nearly half (46%) of the subjects in this study presented with symptoms but had no malaria. Presumptive treatment of malaria may therefore be useful in situations where diagnostic tests are not readily available, its routine practice should however not be encouraged.

Highlights

Malaria still remains one of the greatest threats to the survival of the Sub-Saharan African child today
In terms of symptom distribution, diarrhoea was the baseline criterion for inclusion into the study and had a 100.0% distribution
Malaria in Ghana accounted for about 35.0% of Out Patients Department (OPD) attendance in hospitals in the late 1990s and some researchers believe this prevalence has increased over the years

Summary

Introduction

Malaria still remains one of the greatest threats to the survival of the Sub-Saharan African child today. The WHO in its 2006 treatment guidelines advocated treatment of malaria on grounds of clinical suspicion in areas which have high stable transmission for children less than 5 years [2] In accordance with this directive, malaria treatment in many parts of Africa and Asia where the disease burden is greatest was often dispensed on the basis of certain symptoms which were deemed malaria symptoms. These symptoms included fever, vomiting, anaemia, diarrhoea, cough, and fast breathing. To contribute to the debate, this secondary data analysis was conducted to determine the likelihood of malaria parasitaemia in a child presenting with fever, vomiting, or cough in the KassenaNankana District. Presumptive treatment of malaria may be useful in situations where diagnostic tests are not readily available, its routine practice should not be encouraged

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