Predictive value of fever and palmar pallor for P. falciparum parasitaemia in children from an endemic area
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Predictive value of fever and palmar pallor for P. falciparum parasitaemia in children from an endemic area. / Vinnemeier, Christof David; Schwarz, Norbert Georg; Sarpong, Nimako; Loag, Wibke; Acquah, Samuel; Nkrumah, Bernard; Huenger, Frank; Adu-Sarkodie, Yaw; May, Jürgen.
in: PLOS ONE, Jahrgang 7, Nr. 5, 2012, S. e36678.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Predictive value of fever and palmar pallor for P. falciparum parasitaemia in children from an endemic area
AU - Vinnemeier, Christof David
AU - Schwarz, Norbert Georg
AU - Sarpong, Nimako
AU - Loag, Wibke
AU - Acquah, Samuel
AU - Nkrumah, Bernard
AU - Huenger, Frank
AU - Adu-Sarkodie, Yaw
AU - May, Jürgen
PY - 2012
Y1 - 2012
N2 - INTRODUCTION: Although the incidence of Plasmodium falciparum malaria in some parts of sub-Saharan Africa is reported to decline and other conditions, causing similar symptoms as clinical malaria are gaining in relevance, presumptive anti-malarial treatment is still common. This study traced for age-dependent signs and symptoms predictive for P. falciparum parasitaemia.METHODS: In total, 5447 visits of 3641 patients between 2-60 months of age who attended an outpatient department (OPD) of a rural hospital in the Ashanti Region, Ghana, were analysed. All Children were examined by a paediatrician and a full blood count and thick smear were done. A Classification and Regression Tree (CART) model was used to generate a clinical decision tree to predict malarial parasitaemia a7nd predictive values of all symptoms were calculated.RESULTS: Malarial parasitaemia was detected in children between 2-12 months and between 12-60 months of age with a prevalence of 13.8% and 30.6%, respectively. The CART-model revealed age-dependent differences in the ability of the variables to predict parasitaemia. While palmar pallor was the most important symptom in children between 2-12 months, a report of fever and an elevated body temperature of ≥37.5°C gained in relevance in children between 12-60 months. The variable palmar pallor was significantly (p<0.001) associated with lower haemoglobin levels in children of all ages. Compared to the Integrated Management of Childhood Illness (IMCI) algorithm the CART-model had much lower sensitivities, but higher specificities and positive predictive values for a malarial parasitaemia.CONCLUSIONS: Use of age-derived algorithms increases the specificity of the prediction for P. falciparum parasitaemia. The predictive value of palmar pallor should be underlined in health worker training. Due to a lack of sensitivity neither the best algorithm nor palmar pallor as a single sign are eligible for decision-making and cannot replace presumptive treatment or laboratory diagnosis.
AB - INTRODUCTION: Although the incidence of Plasmodium falciparum malaria in some parts of sub-Saharan Africa is reported to decline and other conditions, causing similar symptoms as clinical malaria are gaining in relevance, presumptive anti-malarial treatment is still common. This study traced for age-dependent signs and symptoms predictive for P. falciparum parasitaemia.METHODS: In total, 5447 visits of 3641 patients between 2-60 months of age who attended an outpatient department (OPD) of a rural hospital in the Ashanti Region, Ghana, were analysed. All Children were examined by a paediatrician and a full blood count and thick smear were done. A Classification and Regression Tree (CART) model was used to generate a clinical decision tree to predict malarial parasitaemia a7nd predictive values of all symptoms were calculated.RESULTS: Malarial parasitaemia was detected in children between 2-12 months and between 12-60 months of age with a prevalence of 13.8% and 30.6%, respectively. The CART-model revealed age-dependent differences in the ability of the variables to predict parasitaemia. While palmar pallor was the most important symptom in children between 2-12 months, a report of fever and an elevated body temperature of ≥37.5°C gained in relevance in children between 12-60 months. The variable palmar pallor was significantly (p<0.001) associated with lower haemoglobin levels in children of all ages. Compared to the Integrated Management of Childhood Illness (IMCI) algorithm the CART-model had much lower sensitivities, but higher specificities and positive predictive values for a malarial parasitaemia.CONCLUSIONS: Use of age-derived algorithms increases the specificity of the prediction for P. falciparum parasitaemia. The predictive value of palmar pallor should be underlined in health worker training. Due to a lack of sensitivity neither the best algorithm nor palmar pallor as a single sign are eligible for decision-making and cannot replace presumptive treatment or laboratory diagnosis.
KW - Algorithms
KW - Child, Preschool
KW - Endemic Diseases
KW - Female
KW - Fever
KW - Humans
KW - Infant
KW - Malaria, Falciparum
KW - Male
KW - Pallor
KW - Parasitemia
KW - Plasmodium falciparum
KW - Predictive Value of Tests
KW - Regression Analysis
U2 - 10.1371/journal.pone.0036678
DO - 10.1371/journal.pone.0036678
M3 - SCORING: Journal article
C2 - 22574213
VL - 7
SP - e36678
JO - PLOS ONE
JF - PLOS ONE
SN - 1932-6203
IS - 5
ER -