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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Treatment guided by rapid diagnostic tests for malaria in Tanzanian children: Safety and alternative bacterial diagnoses
Malaria Journal, Volume 10, Article 290, Year 2011
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Description
Background: WHO guidelines for the treatment of young children with suspected malaria have recently changed from presumptive treatment to anti-malarial treatment guided by a blood slide or malaria rapid diagnostic test (RDT). However, there is limited evidence of the safety of this policy in routine outpatient settings in Africa. Methods. Children 3-59 months of age with a non-severe febrile illness and no obvious cause were enrolled over a period of one year in a malaria endemic area of Tanzania. Treatment was determined by the results of a clinical examination and RDT result, and blood culture and serum lactate were also collected. RDT-negative children were followed up over 14 days. Results: Over the course of one year, 965 children were enrolled; 158 (16.4%) were RDT-positive and treated with artemether-lumefantrine and 807 (83.4%) were RDT-negative and treated with non-anti-malarial medicines. Compared with RDT-positives, RDT-negative children were on average younger with a lower axillary temperature and more likely to have a history of cough or difficulty in breathing. Six (0.6%) children became RDT-positive after enrolment, all of whom were PCR-negative for Plasmodium falciparum DNA at enrolment. In addition, 12 (1.2%) children were admitted to hospital, one with possible malaria, none of whom died. A bacterial pathogen was identified in 9/965 (0.9%) children, eight of whom were RDT-negative and one was RDT-positive, but slide-negative. Excluding three children with Salmonella typhi, all of the children with bacteraemia were 12 months of age. Compared to double-read research slide results RDTs had a sensitivity of 97.8% (95%CI 96.9-98.7) and specificity of 96.3% (95%CI 96.3-98.4). Conclusions: Use of RDTs to direct the use of anti-malarial drugs in young children did not result in any missed diagnoses of malaria although new infections soon after a consultation with a negative RDT result may undermine confidence in results. Invasive bacterial disease is uncommon in children with non-severe illness and most cases occurred in infants with a current fever. © 2011 Mtove et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Mtove, George A.
Unknown Affiliation
Hendriksen, Ilse C.E.
Unknown Affiliation
Amos, Ben
Unknown Affiliation
Mrema, Hedwiga
Unknown Affiliation
Mandia, Victor
Unknown Affiliation
Manjurano, Alphaxard M.
Unknown Affiliation
Muro, Florida J.
Unknown Affiliation
Sykes, Alma
Unknown Affiliation
Hildenwall, Helena
Unknown Affiliation
Whitty, Christopher J.M.
Unknown Affiliation
Reyburn, Hugh G.
Unknown Affiliation
Statistics
Citations: 11
Authors: 11
Affiliations: 7
Identifiers
Doi:
10.1186/1475-2875-10-290
e-ISSN:
14752875
Research Areas
Genetics And Genomics
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Locations
Tanzania