Malaria Treatment & Prevention
How much of childhood fever is actually malaria?
This is related to questions of diagnostics and the fact that clinicians typically treat for malaria when RDTs are negative. The question of the proportion of childhood fevers that are actually malaria is a reasonable one. Of course is all depends on context, but...
I found this study by D'Acremont and colleagues presented at MIM to be really fascinating. In these urban and rural Tanzanian populations the researchers used all possible diagnostic tests to determine the etiology of childhood fevers. Only 12% were malaria.
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Etiology of fever in children from urban and rural Tanzania
[MIM16671706]
V. D’Acremont, M. Kilowoko, E. Kyungu, S. Philipina, W. Sangu,
J. Kahama-Maro, P. Kibatala, E. Kahigwa, C. Lengeler, B. Genton
Previous studies have looked at the proportion of either malaria,
pneumonia, diarrhea, or bacteremia among fevers, but none at
the overall spectrum of etiologies. We aimed at investigating precise
causes of fever episodes in children attending outpatient
clinics in urban/rural settings in Tanzania. All consenting children
aged 2 months to 10 years with temperature >38 ◦C were
recruited, except those requiring immediate support. Detailed
medical history and clinical examination were done and blood
taken to perform rapid tests for malaria and typhoid, blood cultures,
serological and molecular-analyses. All had nasal/throat
swabs taken for viral molecular investigation, urine when no
obvious cause was found and stools when diarrhea was present.
Chest X-rays were performed when IMCI criteria for clinical pneumonia
were met. Each diagnosis was assigned a probability
level (high/moderate/low) based on pre-defined criteria. 1010 (510
Dar es Salaam, 500 Ifakara) children were recruited. Preliminary
results (prior to molecular-analysis) on the causes of fever of high probability
were: 43% acute-respiratory-infection (ARI) (30% URTI,
6% clinical-pneumonia, 7% X-ray-confirmed), 12% malaria, 9% diarrhoea
(3% rotavirus, 6% bacterial/unknown), 8% urine-infection, 4%
typhoid, 2% skin-infection, 1% occult-bacteremia and 21% unknown
at this stage. 8% had more than one diagnoses (high-probability).
These results provide for the first time an accurate picture of the
diversity of causes of fever in African children. ARI (mainly URTI)
contributed to the largest burden of disease. Results of molecular
analyses will provide further insight on respective contribution of
bacteria versus viruses, a critical issue for appropriate management
of fever and rational use of antibiotics.
Email address for correspondence:
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So, in these two contexts presumptive treatments with ACTS would have been wrong 88% of the time. As an anthropologist, I think that part of the question is how different actors define "malaria." There are some good ethnographic studies about this.
