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Diagnosis and treatment of malaria in peripheral health facilities in Uganda: findings from an area of low transmission in south-western Uganda.

Ndyomugyenyi R, Magnussen P, Clarke S - Malar. J. (2007)

Bottom Line: A malaria case was defined as any slide-confirmed parasitaemia in a person with an axillary temperature > or = 37.5 degrees C or a history of fever within the last 24 hrs and no signs suggestive of other diseases.Cases of malaria were significantly more likely to report joint pains, headache, vomiting and abdominal pains.In low-transmission areas, more attention needs to be paid to differential diagnosis of febrile illnesses In view of suggested changes in anti-malarial drug policy, introducing costly artemisinin combination therapy accurate, rapid diagnostic tools are necessary to target treatment to people in need.

View Article: PubMed Central - HTML - PubMed

Affiliation: Vector Control, Division, Ministry of Health, Kampala, Uganda. notf@vcdmoh.go.ug <notf@vcdmoh.go.ug>

ABSTRACT

Background: Early recognition of symptoms and signs perceived as malaria are important for effective case management, as few laboratories are available at peripheral health facilities. The validity and reliability of clinical signs and symptoms used by health workers to diagnose malaria were assessed in an area of low transmission in south-western Uganda.

Methods: The study had two components: 1) passive case detection where all patients attending the out patient clinic with a febrile illness were included and 2) a longitudinal active malaria case detection survey was conducted in selected villages. A malaria case was defined as any slide-confirmed parasitaemia in a person with an axillary temperature > or = 37.5 degrees C or a history of fever within the last 24 hrs and no signs suggestive of other diseases.

Results: Cases of malaria were significantly more likely to report joint pains, headache, vomiting and abdominal pains. However, due to the low prevalence of malaria, the predictive values of these individual signs alone, or in combination, were poor. Only 24.8% of 1627 patients had malaria according to case definition and > 75% of patients were unnecessarily treated for malaria and few slide negative cases received alternative treatment.

Conclusion: In low-transmission areas, more attention needs to be paid to differential diagnosis of febrile illnesses In view of suggested changes in anti-malarial drug policy, introducing costly artemisinin combination therapy accurate, rapid diagnostic tools are necessary to target treatment to people in need.

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Relationship between presumptive and certified malaria cases and rainfall in Kabale district during the period December 2001 to March 2000.
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Figure 1: Relationship between presumptive and certified malaria cases and rainfall in Kabale district during the period December 2001 to March 2000.

Mentions: A blood slide was prepared for 1577 (96.9%) of the patients suspected to be having malaria and 794 (50.3%) were found to be parasitaemic. Overall, 391 (24.8%) were classified as malaria cases according to the case definition (axillary temperature ≥ 37.5°C with positive blood slide confirmation): with 29.4%, 23.6% and 24.8% in the age groups < 5, 5–15 and ≥ 16 years respectively (table 1). The numbers of presumptive malaria cases were much higher than the certified cases for all months in the year. Although there was no marked seasonality, both presumptive and certified malaria cases tended to peak after the peaks of rainfall (Figure 1). As shown in Table 1, 435 (27.6%) patients had an elevated temperature without malaria parasitaemia. An elevated temperature in the absence of parasitaemia was highest amongst pre-school children, with 43.5%, 23.5% and 27.6% in the age groups < 5, 5–15 and ≥ 16 years respectively, (P = 0.001). Not all parasitaemic cases were febrile. Parasitaemia in the absence of demonstrable fever was found in 25.6% of patients overall, and was more common in older children and adults with 14.1%, 27.8% and 25.8% in the age groups < 5, 5–15 and 16 years respectively, (P = 0.03). Parasite density was generally low with only 25 % of the patients having parasite density ≥ 1,000/μl of blood.


Diagnosis and treatment of malaria in peripheral health facilities in Uganda: findings from an area of low transmission in south-western Uganda.

Ndyomugyenyi R, Magnussen P, Clarke S - Malar. J. (2007)

Relationship between presumptive and certified malaria cases and rainfall in Kabale district during the period December 2001 to March 2000.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1851016&req=5

Figure 1: Relationship between presumptive and certified malaria cases and rainfall in Kabale district during the period December 2001 to March 2000.
Mentions: A blood slide was prepared for 1577 (96.9%) of the patients suspected to be having malaria and 794 (50.3%) were found to be parasitaemic. Overall, 391 (24.8%) were classified as malaria cases according to the case definition (axillary temperature ≥ 37.5°C with positive blood slide confirmation): with 29.4%, 23.6% and 24.8% in the age groups < 5, 5–15 and ≥ 16 years respectively (table 1). The numbers of presumptive malaria cases were much higher than the certified cases for all months in the year. Although there was no marked seasonality, both presumptive and certified malaria cases tended to peak after the peaks of rainfall (Figure 1). As shown in Table 1, 435 (27.6%) patients had an elevated temperature without malaria parasitaemia. An elevated temperature in the absence of parasitaemia was highest amongst pre-school children, with 43.5%, 23.5% and 27.6% in the age groups < 5, 5–15 and ≥ 16 years respectively, (P = 0.001). Not all parasitaemic cases were febrile. Parasitaemia in the absence of demonstrable fever was found in 25.6% of patients overall, and was more common in older children and adults with 14.1%, 27.8% and 25.8% in the age groups < 5, 5–15 and 16 years respectively, (P = 0.03). Parasite density was generally low with only 25 % of the patients having parasite density ≥ 1,000/μl of blood.

Bottom Line: A malaria case was defined as any slide-confirmed parasitaemia in a person with an axillary temperature > or = 37.5 degrees C or a history of fever within the last 24 hrs and no signs suggestive of other diseases.Cases of malaria were significantly more likely to report joint pains, headache, vomiting and abdominal pains.In low-transmission areas, more attention needs to be paid to differential diagnosis of febrile illnesses In view of suggested changes in anti-malarial drug policy, introducing costly artemisinin combination therapy accurate, rapid diagnostic tools are necessary to target treatment to people in need.

View Article: PubMed Central - HTML - PubMed

Affiliation: Vector Control, Division, Ministry of Health, Kampala, Uganda. notf@vcdmoh.go.ug <notf@vcdmoh.go.ug>

ABSTRACT

Background: Early recognition of symptoms and signs perceived as malaria are important for effective case management, as few laboratories are available at peripheral health facilities. The validity and reliability of clinical signs and symptoms used by health workers to diagnose malaria were assessed in an area of low transmission in south-western Uganda.

Methods: The study had two components: 1) passive case detection where all patients attending the out patient clinic with a febrile illness were included and 2) a longitudinal active malaria case detection survey was conducted in selected villages. A malaria case was defined as any slide-confirmed parasitaemia in a person with an axillary temperature > or = 37.5 degrees C or a history of fever within the last 24 hrs and no signs suggestive of other diseases.

Results: Cases of malaria were significantly more likely to report joint pains, headache, vomiting and abdominal pains. However, due to the low prevalence of malaria, the predictive values of these individual signs alone, or in combination, were poor. Only 24.8% of 1627 patients had malaria according to case definition and > 75% of patients were unnecessarily treated for malaria and few slide negative cases received alternative treatment.

Conclusion: In low-transmission areas, more attention needs to be paid to differential diagnosis of febrile illnesses In view of suggested changes in anti-malarial drug policy, introducing costly artemisinin combination therapy accurate, rapid diagnostic tools are necessary to target treatment to people in need.

Show MeSH
Related in: MedlinePlus