Abstract

BackgroundThe current roll-out of rapid diagnostic tests (RDTs) in many endemic countries has resulted in the reporting of fewer cases of malaria-attributed illnesses. However, lack of knowledge of the prevalence of other febrile illnesses and affordable diagnostic tests means that febrile patients are not managed optimally. This study assessed the prevalence of commonly treatable or preventable febrile illnesses in children between 6 months and 15 years using rapid diagnostic tests at the point-of-care.MethodsFebrile children were enrolled between February-April 2014 at a health facility after obtaining informed consent from parent. Eligible participants were aged 6 months-15 years with a history of fever in the last 24 h or axillary temperature ≥38 °C at consultation. All participants were tested using RDTs for malaria, typhoid, toxoplasmosis and rubella. Malaria parasites were further identified by microscopy and PCR. Clinical and household characteristics were recorded and association with pathogens determined.ResultsOf the 315 children enrolled, the mean age was 5.8 ± 3.8 years. Stomach pain (41.2 %) was the most reported symptom. Prior to attending the health facility, 70.8 % had taken antipyretics, 27.9 % antimalarials, 11.4 % antibiotics and 13.3 % antifungal drugs. Among 315 children with fever, based on RDTs, 56.8 % were infected with malaria, 4.4 % with typhoid, 3.2 % with acute toxoplasmosis, and 1.3 % with rubella (all positive for rubella were in the same family and not vaccinated). All non-malarial infections were co-infections and approximately 30 % of the fever cases went un-diagnosed. Malaria prevalence by microscopy and PCR was 43.4 and 70.2 % respectively. The sensitivity and specificity of RDTs for the diagnosis of malaria were 75.98 and 100 % respectively, with 0.73 measurement agreement between RDTs and microscopy while that of RDT and PCR were 81 and 100 % respectively with a K value of 0.72. The use of Insecticide Treated Bednets was 44 %. There was a significant association between ITN non-usage and malaria (p = 0. 029) as well as drinking water and presence of typhoid (p = 0.047). No association was observed between type of housing and malaria, or toxoplasmosis and raising cats.ConclusionThough malaria still remains the major cause of fever in children, using RDTs for other treatable febrile illnesses like typhoid and toxoplasmosis could facilitate the optimal management of febrile illnesses in children especially when these occur as co-infections with malariaElectronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1996-y) contains supplementary material, which is available to authorized users.

Highlights

  • The current roll-out of rapid diagnostic tests (RDTs) in many endemic countries has resulted in the reporting of fewer cases of malaria-attributed illnesses

  • Since information on the prevalence of toxoplasmosis, rubella and typhoid for children with fever was not known, sample size was calculated based on malaria morbidity in children (38 %) as indicated in the National Malaria Control Program (NMCP) report in 2011 [3] taking into consideration the resources for the study

  • All the 315 children in this study presented with fever and other symptoms that are common to malaria and other febrile illnesses like typhoid, toxoplasmosis and rubella confirming the need for a differential diagnosis of febrile illnesses as reported in many other malaria endemic countries [10,11,12,13,14,15,16,17,18,19,20,21]

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Summary

Introduction

The current roll-out of rapid diagnostic tests (RDTs) in many endemic countries has resulted in the reporting of fewer cases of malaria-attributed illnesses. Lack of knowledge of the prevalence of other febrile illnesses and affordable diagnostic tests means that febrile patients are not managed optimally. This study assessed the prevalence of commonly treatable or preventable febrile illnesses in children between 6 months and 15 years using rapid diagnostic tests at the point-of-care. A wide range of treatable or preventable pathogens are known to cause fever in patients who present with malaria-like symptoms, but do not have malaria [1]. Malaria continues to be the major cause of mortality in Cameroon and accounts for 35–40 % of all deaths, with 50 % of morbidity among children under the age of five with a considerable drop in morbidity observed between 2008–2011 [2, 3]. Serious consideration of other etiologies may not occur unless there is no clinical response to antimalarials treatment

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