Frequency and correlates of malaria over-treatment in areas of differing malaria transmission: a cross-sectional study in rural Western Kenya

Malaria Journal

Research

Barbra A Richardson¹  Patricia B Pavlinac²  Carey Farquhar³  Judd L Walson⁴  Grace John-Stewart⁴  Frankline M Onchiri⁵  Benson O Singa⁶  Jacqueline M Naulikha⁷  Elizabeth A Odundo⁸ 

[1] Department of Biostatistics, University of Washington, Seattle, USA;Department of Global Health, University of Washington, Seattle, USA;Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, USA;Department of Epidemiology, University of Washington, Box 359909, 325 Ninth Avenue, 98104, Seattle, WA, USA;Department of Epidemiology, University of Washington, Box 359909, 325 Ninth Avenue, 98104, Seattle, WA, USA;Department of Global Health, University of Washington, Seattle, USA;Department of Medicine, University of Washington, Seattle, USA;Department of Epidemiology, University of Washington, Box 359909, 325 Ninth Avenue, 98104, Seattle, WA, USA;Department of Pediatrics, University of Washington, Seattle, USA;Department of Global Health, University of Washington, Seattle, USA;Department of Medicine, University of Washington, Seattle, USA;Department of Epidemiology, University of Washington, Box 359909, 325 Ninth Avenue, 98104, Seattle, WA, USA;Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya;Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya;Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya;Department of Pediatrics, University of Washington, Seattle, USA;Walter Reed Project, United States Army Medical Research Unit, Kericho, Kenya;

关键词: Malaria;    Laboratory testing;    Over-treatment;   

DOI  :  10.1186/s12936-015-0613-7

 received in 2014-09-10, accepted in 2015-02-13,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundIn 2010, the World Health Organization shifted its malaria guidelines from recommending the empiric treatment of all febrile children to treating only those with laboratory-confirmed malaria. This study evaluated the frequency and predictors of malaria over-treatment among febrile malaria-negative children in Kenya.MethodsBetween 2012 and 2013, 1,362 children presenting consecutively with temperature ≥37.5°C to Kisii and Homa Bay hospitals were enrolled in a cross-sectional study evaluating causes of fever. Children were screened for malaria using smear microscopy and rapid diagnostic tests and managed according to standard of care at the hospitals. The frequency of anti-malarial prescriptions among children with laboratory-confirmed malaria negative children (malaria over-treatment) was determined; and clinical and demographic correlates of overtreatment evaluated using logistic regression. Because of differences in malaria endemicity, analyses were stratified and compared by site.ResultsAmong 1,362 children enrolled, 46 (7%) of 685 children in Kisii, and 310 (45.8%) of 677 in Homa Bay had laboratory-confirmed malaria; p < 0.001. Among malaria-negative children; 210 (57.2%) in Homa Bay and 45 (7.0%) in Kisii received anti-malarials; p < 0.001. Predictors of over-treatment in Homa Bay included ≥ one integrated management of childhood illness (IMCI) danger sign (aOR = 8.47; 95% CI: 4.81-14.89), fever lasting ≥ seven days (aOR = 4.94; 95% CI: 1.90-12.86), and fever ≥39°C (aOR = 3.07; 95% CI: 1.58-5.96). In Kisii, only fever ≥39°C predicted over-treatment (aOR = 2.13; 95% CI: 1.02-4.45).ConclusionsMalaria over-treatment was common, particularly in Homa Bay, where the prevalence of malaria was extremely high. Severe illness and high or prolonged fever were associated with overtreatment. Overtreatment may result in failure to treat other serious causes of fever, drug resistance, and unnecessarily treatment costs.

【 授权许可】

CC BY   
© Onchiri et al.; licensee BioMed Central. 2015