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Prescribing practice for malaria following introduction of artemether-lumefantrine in an urban area with declining endemicity in West Africa.

Okebe JU, Walther B, Bojang K, Drammeh S, Schellenberg D, Conway DJ, Walther M - Malar. J. (2010)

Bottom Line: Slide reading results from the PHFs were compared to the reference readings and the proportion of cases treated but with a negative test result at the reference laboratory was determined.In the same period, requests were commoner in under-fives compared to older children (p = 0.022); however, a positive test result was 4.4 times more likely in the latter group (p = 0.010).The data suggest that laboratory facilities may be under-used, and that adherence to negative PHF slide results could significantly reduce the degree of overtreatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: Malaria Programme, Medical Research Council (UK), Atlantic Boulevard, Fajara, PO Box 273 Banjul, The Gambia. jokebe@mrc.gm

ABSTRACT

Background: The decline in malaria coinciding with the introduction of newer, costly anti-malarials has prompted studies into the overtreatment for malaria mostly in East Africa. The study presented here describes prescribing practices for malaria at health facilities in a West African country.

Methods: Cross-sectional surveys were carried out in two urban Gambian primary health facilities (PHFs) during and outside the malaria transmission season. Facilities were comparable in terms of the staffing compliment and capability to perform slide microscopy. Patients treated for malaria were enrolled after consultations and blood smears collected and read at a reference laboratory. Slide reading results from the PHFs were compared to the reference readings and the proportion of cases treated but with a negative test result at the reference laboratory was determined.

Results: Slide requests were made for 33.2% (173) of those enrolled, being more frequent in children (0-15 yrs) than adults during the wet season (p = 0.003). In the same period, requests were commoner in under-fives compared to older children (p = 0.022); however, a positive test result was 4.4 times more likely in the latter group (p = 0.010). Parasitaemia was confirmed for only 4.7% (10/215) and 12.5% (37/297) of patients in the dry and wet seasons, respectively. The negative predictive value of a PHF slide remained above 97% in both seasons.

Conclusions: The study provides evidence for considerable overtreatment for malaria in a West African setting comparable to reports from areas with similar low malaria transmission in East Africa. The data suggest that laboratory facilities may be under-used, and that adherence to negative PHF slide results could significantly reduce the degree of overtreatment. The "peak prevalence" in 5-15 year olds may reflect successful implementation of malaria control interventions in under-fives, but point out the need to extend such interventions to older children.

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Distribution of patients between seasons showing numbers (%) in the different comparison groups studied.
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Figure 1: Distribution of patients between seasons showing numbers (%) in the different comparison groups studied.

Mentions: About 8,410 patients were recorded as being treated for malaria at both facilities during the study period; 1,502 in the dry and 6,908 in the wet seasons respectively. A total of 521 patients treated for malaria were enrolled, but analysis was carried out using data for 513 patients; 215 and 298 during the dry and wet seasons respectively (eight entries were excluded due to incomplete data)(Figure 1). The distribution of patients by age category and sex in both survey periods is shown in Table 1. All but five patients reported a history of fever with a median duration of three days (range 1 - 60 days) before presentation, although temperatures were not measured routinely at the PHFs.


Prescribing practice for malaria following introduction of artemether-lumefantrine in an urban area with declining endemicity in West Africa.

Okebe JU, Walther B, Bojang K, Drammeh S, Schellenberg D, Conway DJ, Walther M - Malar. J. (2010)

Distribution of patients between seasons showing numbers (%) in the different comparison groups studied.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2902498&req=5

Figure 1: Distribution of patients between seasons showing numbers (%) in the different comparison groups studied.
Mentions: About 8,410 patients were recorded as being treated for malaria at both facilities during the study period; 1,502 in the dry and 6,908 in the wet seasons respectively. A total of 521 patients treated for malaria were enrolled, but analysis was carried out using data for 513 patients; 215 and 298 during the dry and wet seasons respectively (eight entries were excluded due to incomplete data)(Figure 1). The distribution of patients by age category and sex in both survey periods is shown in Table 1. All but five patients reported a history of fever with a median duration of three days (range 1 - 60 days) before presentation, although temperatures were not measured routinely at the PHFs.

Bottom Line: Slide reading results from the PHFs were compared to the reference readings and the proportion of cases treated but with a negative test result at the reference laboratory was determined.In the same period, requests were commoner in under-fives compared to older children (p = 0.022); however, a positive test result was 4.4 times more likely in the latter group (p = 0.010).The data suggest that laboratory facilities may be under-used, and that adherence to negative PHF slide results could significantly reduce the degree of overtreatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: Malaria Programme, Medical Research Council (UK), Atlantic Boulevard, Fajara, PO Box 273 Banjul, The Gambia. jokebe@mrc.gm

ABSTRACT

Background: The decline in malaria coinciding with the introduction of newer, costly anti-malarials has prompted studies into the overtreatment for malaria mostly in East Africa. The study presented here describes prescribing practices for malaria at health facilities in a West African country.

Methods: Cross-sectional surveys were carried out in two urban Gambian primary health facilities (PHFs) during and outside the malaria transmission season. Facilities were comparable in terms of the staffing compliment and capability to perform slide microscopy. Patients treated for malaria were enrolled after consultations and blood smears collected and read at a reference laboratory. Slide reading results from the PHFs were compared to the reference readings and the proportion of cases treated but with a negative test result at the reference laboratory was determined.

Results: Slide requests were made for 33.2% (173) of those enrolled, being more frequent in children (0-15 yrs) than adults during the wet season (p = 0.003). In the same period, requests were commoner in under-fives compared to older children (p = 0.022); however, a positive test result was 4.4 times more likely in the latter group (p = 0.010). Parasitaemia was confirmed for only 4.7% (10/215) and 12.5% (37/297) of patients in the dry and wet seasons, respectively. The negative predictive value of a PHF slide remained above 97% in both seasons.

Conclusions: The study provides evidence for considerable overtreatment for malaria in a West African setting comparable to reports from areas with similar low malaria transmission in East Africa. The data suggest that laboratory facilities may be under-used, and that adherence to negative PHF slide results could significantly reduce the degree of overtreatment. The "peak prevalence" in 5-15 year olds may reflect successful implementation of malaria control interventions in under-fives, but point out the need to extend such interventions to older children.

Show MeSH
Related in: MedlinePlus