Preventive Therapy For Malaria Research Articles

Rapid Diagnostic Test Versus Microscopy for Diagnosing Malaria Among Pregnant Women in a Resource-Poor Setting; A Cross-Sectional Comparative Study

BACKGROUND: Diagnostic challenge of malaria in Nigeria remarkably impedes the World Health Organization (WHO) recommendation of laboratory diagnosis before treatment. Rapid Diagnostic Test (RDT) is easier and cheaper to perform when compared with microscopy especially in resource-poor settings. However there are conflicting results on the accuracy of RDT versus microscopy from previous studies. 
 
 AIM: To compare the overall accuracy of   microscopy and RDT in detecting peripheral malaria among   pregnant women with clinical features of malaria.
 
 MATERIALS & METHODS: This was a cross-sectional comparative studyin whichRDT, microscopy and polymerase chain reaction (PCR) were performed using the peripheral bloodof the eligible study participants at the Alex Ekwueme Federal University Teaching Hospital, Abakaliki between September 1, 2016 and March 31, 2017.The PCR was used as the gold standard in this study. Data was analyzed with the Statistical Package for Social Sciences version 18 (IBM SPSS, Chicago, USA). P value ≤ 0.05 was considered statistically significant.
 
 RESULTS: The actual prevalent rates of malaria based on RDT, microscopy and PCR results among the participants were 58.2%, 59.9% and 61.1% respectively. There was no statistical significant difference among RDT, microscopy and combined RDT and microscopy on overall accuracy. Malaria infestation was associated with self-employed and unemployed women, primigravidity, second trimester, rural residence, non-use of long lasting insecticide treated nets and intermittent preventive therapy for malaria. 
 
 CONCLUSION: There was no difference in overall accuracy among RDT, microscopy and combined RDT and microscopy. This underscores the need to scale up RDT for every patient with clinical features of malaria before treatment in this environment.

Use of Intermittent Preventive Therapy for Malaria During Pregnancy and Development of Febrile Illness Among Infants in Nigeria

In most African countries, a good number of pregnant women make multiple antenatal visits providing a major opportunity for the prevention of malaria (associated with febrile illness) in infants through the use of intermittent preventive treatment in pregnancy (IPTp). This study assessed the association between maternal use of IPTp with sulphadoxine and pyrimethamine (SP) and the development of febrile illness in infants. This was a secondary data analysis of the 2013 Nigeria Demographic Health Survey (NDHS) data. Mother-child pairs where the mother was aged 15-49 years and the child was less than one year at the time of the survey were included. Variables such as the use of IPTp-SP and development of febrile illness as well as the socio-demographic and other control variable were analyzed. Chi-square testing and logistic regression were used to determine the association between the use of IPTp-SP and the development of febrile illness. Statistical analysis was done using SPSS version 21 and Statistical significance was set at P<0.05. A total of 6,212 mother-child pairs were analyzed. Chi-square test showed that there was a significant association between the use of IPTp-SP and report of fever in infants. A higher proportion of mothers that used IPTp-SP (15.8%) reported fever in their infants compared with those whose mother did not receive IPTp-SP (11.6%) (P<0.001). Logistic regression showed that mothers that used IPTp-SP were about one and half times more likely to report fever in their infants, before adjustment for confounding variables (OR = 1.46, 95% CI: 1.24 – 1.71, p<0.001). Following adjustment, there was a weaker (though still significant) association between IPTp-SP use and fever in the infants (OR = 1.26, 95% CI: 1.04 – 1.52, p = 0.019). This study found a significant association between the use of IPTp-SP and mothers' report of febrile illness among infants in the two weeks before the survey. This requires further evidence to confirm but highlights the complex relationship between maternal drug exposure and long term susceptibility to illness in offspring.

Febrile Illnesses

Roughly 10% of travelers to developing countries experience a febrile illness during travel or on return. The likelihood of developing a medical condition during travel relates to an individual's past medical history, travel destination, duration of travel, level of accommodation, immunization history, adherence to indicated chemoprophylactic regimens, activities during travel, and history of exposure to infectious agents prior to and during travel. The risk for acquiring a tropical infection is primarily affected by the activities of the traveler. For example, immigrants from developing countries return home to visit friends and relatives (VFR) in their place of birth and usually don’t take preventive therapy for malaria. Long-term expatriates, on the other hand, have unique risk profiles. Fever is a leading reason for post travel consultation. Careful questioning of patients about the pattern of fever and associated symptoms is useful. Several papers around the world have reported data about returning travelers with fever. The Geosentinel has reviewed its data on 24,920 travelers from 1997 to 2006. They reported that 28% of returned travelers seen at clinics presented with fever as their chief reason for seeking medical care. Fever was a marker of a serious illness requiring hospitalization. In this report, causes of fever varied by region visited and by time of presentation after travel. The exposure history is crucial to the formulation of a differential diagnosis. Knowledge of infectious disease outbreaks like the novel H1N1 Influenza pandemics in a specific region where the patient has traveled is very helpful. Travelers to Latin America can be exposed to different infectious agents that can give a systemic febrile illness. The most common ones include respiratory tract infections, mononucleosis, dengue, malaria, and typhoid fever. Sometimes no specific cause is reported. Laboratory diagnosis has to be done promptly and efficaciously to avoid delays in treatment. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive