Challenges in Diagnosing and Treating Acutely Febrile Children with Suspected Malaria at Health Care Facilities in the Lake Mwanza Region of Tanzania
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Challenges in Diagnosing and Treating Acutely Febrile Children with Suspected Malaria at Health Care Facilities in the Lake Mwanza Region of Tanzania. / Koliopoulos, Philip; Kayange, Neema; Jensen, Christian; Gröndahl, Britta; Eichmann, Jana; Daniel, Tim; Huth, Florian; Eckert, Till; Klamm, Nele; Follmann, Marlene; Medina-Montaño, Grey Carolina; Hokororo, Adolfine; Pretsch, Leah; Klüber, Julia; Schmidt, Christian; Züchner, Antke; Addo, Marylyn M; Okamo, Bernard; Mshana, Stephen E; Gehring, Stephan.
In: AM J TROP MED HYG, Vol. 110, No. 2, 07.02.2024, p. 202-208.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Challenges in Diagnosing and Treating Acutely Febrile Children with Suspected Malaria at Health Care Facilities in the Lake Mwanza Region of Tanzania
AU - Koliopoulos, Philip
AU - Kayange, Neema
AU - Jensen, Christian
AU - Gröndahl, Britta
AU - Eichmann, Jana
AU - Daniel, Tim
AU - Huth, Florian
AU - Eckert, Till
AU - Klamm, Nele
AU - Follmann, Marlene
AU - Medina-Montaño, Grey Carolina
AU - Hokororo, Adolfine
AU - Pretsch, Leah
AU - Klüber, Julia
AU - Schmidt, Christian
AU - Züchner, Antke
AU - Addo, Marylyn M
AU - Okamo, Bernard
AU - Mshana, Stephen E
AU - Gehring, Stephan
PY - 2024/2/7
Y1 - 2024/2/7
N2 - Acute febrile diseases transmitted by mosquitos are a diagnostic challenge for pediatricians working in sub-Saharan Africa. Misclassification due to the lack of rapid, reliable diagnostic tests leads to the overuse of antibiotics and antimalarials. Children presenting with acute fever and suspected of having malaria were examined at health care facilities in the Mwanza Region of Tanzania. The sensitivity and specificity of blood smear microscopy and malaria rapid diagnostic tests that targeted histidine-rich protein 2 and Plasmodium lactate dehydrogenase were compared with a multiplex reverse transcriptase-polymerase chain reaction (PCR)-ELISA. Six hundred ninety-eight children presented with acute fever and met the criteria for inclusion; 23% received antibiotics and 23% received antimalarials prior to admission. Subsequently, 20% were confirmed by PCR to have Plasmodium falciparum infection. Blood smear microscopy exhibited 33% sensitivity and 93% specificity. The malaria rapid test provided 87% sensitivity and 98% specificity in detecting acute malaria infections. Only 7% of malaria-negative children received antimalarials at Sengerema Designated District Hospital when treatment was guided by the results of rapid testing. In contrast, 75% of malaria-negative patients were treated with antimalarial drugs at health facilities that used blood smears as the standard diagnostic test. Misclassification and premedication of nonmalarial, febrile illnesses contribute to the emergence of antimalarial and antimicrobial resistance. The incorporation of malaria rapid diagnostic tests into the clinical routine translated into improved treatment and a significant reduction in antimalarial drug prescriptions.
AB - Acute febrile diseases transmitted by mosquitos are a diagnostic challenge for pediatricians working in sub-Saharan Africa. Misclassification due to the lack of rapid, reliable diagnostic tests leads to the overuse of antibiotics and antimalarials. Children presenting with acute fever and suspected of having malaria were examined at health care facilities in the Mwanza Region of Tanzania. The sensitivity and specificity of blood smear microscopy and malaria rapid diagnostic tests that targeted histidine-rich protein 2 and Plasmodium lactate dehydrogenase were compared with a multiplex reverse transcriptase-polymerase chain reaction (PCR)-ELISA. Six hundred ninety-eight children presented with acute fever and met the criteria for inclusion; 23% received antibiotics and 23% received antimalarials prior to admission. Subsequently, 20% were confirmed by PCR to have Plasmodium falciparum infection. Blood smear microscopy exhibited 33% sensitivity and 93% specificity. The malaria rapid test provided 87% sensitivity and 98% specificity in detecting acute malaria infections. Only 7% of malaria-negative children received antimalarials at Sengerema Designated District Hospital when treatment was guided by the results of rapid testing. In contrast, 75% of malaria-negative patients were treated with antimalarial drugs at health facilities that used blood smears as the standard diagnostic test. Misclassification and premedication of nonmalarial, febrile illnesses contribute to the emergence of antimalarial and antimicrobial resistance. The incorporation of malaria rapid diagnostic tests into the clinical routine translated into improved treatment and a significant reduction in antimalarial drug prescriptions.
U2 - 10.4269/ajtmh.23-0254
DO - 10.4269/ajtmh.23-0254
M3 - SCORING: Journal article
C2 - 38150741
VL - 110
SP - 202
EP - 208
JO - AM J TROP MED HYG
JF - AM J TROP MED HYG
SN - 0002-9637
IS - 2
ER -