Abstract
BackgroundA recent school-based study in Benin showed that applying a policy of anti-malarial prescriptions restricted to parasitologically-confirmed cases on the management of fever is safe and feasible. Additional PCR data were analysed in order to touch patho-physiological issues, such as the usefulness of PCR in the management of malaria in an endemic area or the triggering of a malaria attack in children with submicroscopic malaria.MethodsPCR data were prospectively collected in the setting of an exposed (with fever)/non exposed (without fever) study design. All children had a negative malaria rapid diagnostic test (RDT) at baseline, were followed up to day 14 and did not receive drugs with anti-malarial activity. The index group was defined by children with fever at baseline and the control group by children without fever at baseline. Children with submicroscopic malaria in these two groups were defined by a positive PCR at baseline.ResultsPCR was positive in 66 (27%) children of the index group and in 104 (44%) children of the control group respectively. The only significant factor positively related to PCR positivity at baseline was the clinical status (control group). When definition of malaria attacks included PCR results, no difference of malaria incidence was observed between the index and control groups, neither in the whole cohort, nor in children with submicroscopic malaria. The rate of undiagnosed malaria at baseline was estimated to 3.7% at baseline in the index group.ConclusionsTreating all children with fever and a positive PCR would have led to a significant increase of anti-malarial consumption, with few benefits in terms of clinical events. Non malarial fevers do not or do not frequently trigger malaria attacks in children with submicroscopic malaria.
Highlights
A recent school-based study in Benin showed that applying a policy of anti-malarial prescriptions restricted to parasitologically-confirmed cases on the management of fever is safe and feasible
Submicroscopic malaria is frequent in endemic areas, and no study yet has dissected the consequences of applying the algorithm of management of fever by asking the following questions: what would be the consequences in many endemic areas of treating with anti-malarials all febrile children with a malarial infection, as detected by PCR? and are children with submicroscopic malarial infections prone to develop malaria attacks soon after the occurrence of a non malarial fever?
The index group was defined by children with fever at baseline, and the control group by children without fever at baseline
Summary
A recent school-based study in Benin showed that applying a policy of anti-malarial prescriptions restricted to parasitologically-confirmed cases on the management of fever is safe and feasible. Restricting anti-malarials to parasitologically-confirmed cases has been recommended in many countries for children of five years of age or above. Providing that no diagnostic tool is perfect, a school-based prospective study Are children with submicroscopic malarial infections prone to develop malaria attacks soon after the occurrence of a non malarial fever?. During the follow-up an undiagnosed P. falciparum malaria at enrolment was defined as 1) at least one test (including PCR) positive at enrolment, 2) fever occurring during follow-up 3) at least one test (including PCR) positive for a P. falciparum infection at the time of fever
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