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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Sensitivity of fever for diagnosis of clinical malaria in a Kenyan area of unstable, low malaria transmission
Malaria Journal, Volume 13, No. 1, Article 163, Year 2014
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Description
Background: Malaria in highland areas of Kenya affects children and adults. Local clinicians include symptoms other than fever when screening for malaria because they believe that fever alone does not capture all cases of malaria. Methods. Individuals who presented to dispensaries in a highland Kenya site of low, unstable malaria transmission from 2007-2011 with 1 or more of 11 symptoms were tested by microscopy for malaria. Clinical malaria was defined as asexual Plasmodium falciparum infection on peripheral blood smear in an individual with any screening symptom. Asymptomatic P. falciparum infection was assessed in a cohort at ten time points to determine the extent to which symptomatic episodes with parasitaemia might be attributable to baseline (asymptomatic) parasitaemia in the community. Results: 3,420 individuals were screened for malaria, 634 < 5 years of age and 2,786 ≥ 5 years of age. For the diagnosis of clinical malaria, the symptom of fever had a sensitivity and specificity of 88.9% and15.4% in children <5 years, and 55.8% and 54.4% in children ≥5 years, respectively. Adding the symptom of headache increased sensitivity to 94. 4% in children <5 years and 96.8% in individuals ≥5 years, but decreased specificity to 9.9% and 11.6%, respectively, and increased the number of individuals who would be tested by 6% and 92%, respectively. No combination of symptoms improved upon the presence fever or headache for detection of clinical malaria. In the cohort of asymptomatic individuals, P. falciparum parasitaemia was infrequent (0.1%). Conclusion: In areas of low, unstable malaria transmission, fever is a sensitive indicator of clinical malaria in children <5 years, but not in older children and adults. Adding headache to fever as screening symptom increases sensitivity of detection in individuals ≥5 years old at the cost of decreased specificity. Screening for symptoms in addition to fever may be required to accurately capture all cases of clinical malaria in individuals ≥5 years old in areas of low malaria transmission. © 2014 Mutanda et al.; licensee BioMed Central Ltd.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC4021053/bin/1475-2875-13-163-S1.doc
https://efashare.b-cdn.net/share/pmc/articles/PMC4021053/bin/1475-2875-13-163-S2.doc
https://efashare.b-cdn.net/share/pmc/articles/PMC4021053/bin/1475-2875-13-163-S3.doc
Authors & Co-Authors
Mutanda, Albino L.
Kenya, Maseno
Maseno University
Kenya, Nairobi
Kenya Medical Research Institute
Cheruiyot, Priscah
Kenya, Nairobi
Kenya Medical Research Institute
Hodges, James Steven
United States, Minneapolis
School of Public Health
Ayodo, George A.
Kenya, Nairobi
Kenya Medical Research Institute
Odero, Wilson W.O.
Kenya
School of Medicine
John, Chandy Chiramukhathu
United States, Minneapolis
University of Minnesota Twin Cities
Statistics
Citations: 6
Authors: 6
Affiliations: 5
Identifiers
Doi:
10.1186/1475-2875-13-163
e-ISSN:
14752875
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Study Locations
Kenya