What would PCR assessment change in the management of fevers in a malaria endemic area? A school-based study in Benin in children with and without fever

Malaria Journal

Research

Grace Abiou¹  Agnès Aubouy²  Justin Doritchamou²  Todoégnon Béhéton²  Jean-François Faucher³  Michel Cot⁴  Philippe Deloron⁴  Patrick Makoutode⁵  Edgard Ouendo⁵  Pascal Houzé⁶ 

[1] Faculty of Health Sciences, Department of Parasitology, Champ de Foire, 01BP 188, Cotonou, Benin;Institut de Recherche pour le Développement (IRD), UMR 216: Mother and Child face with Tropical infections Research Unit, Paris, France;Institut de Recherche pour le Développement (IRD), UMR 216: Mother and Child face with Tropical infections Research Unit, Paris, France;Departement of Infectious Diseases, Besançon University Medical Center, 25030, Besançon cedex, France;Institut de Recherche pour le Développement (IRD), UMR 216: Mother and Child face with Tropical infections Research Unit, Paris, France;Université Paris Descartes, Faculté de Pharmacie, 4 avenue de l'Observatoire, 75006, Paris, France;Regional Public Health Institute of Ouidah, 01BP 918, Cotonou, Benin;Saint-Louis Hospital biochemistry laboratory, 1 avenue Claude-Vellefaux, 75010, Paris, France;

关键词: Malaria;    Blood Smear;    Falciparum Malaria;    Rapid Diagnostic Test;    Malaria Incidence;   

DOI  :  10.1186/1475-2875-9-224

 received in 2010-05-31, accepted in 2010-08-06,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundA recent school-based study in Benin showed that applying a policy of anti-malarial prescriptions restricted to parasitologically-confirmed cases on the management of fever is safe and feasible. Additional PCR data were analysed in order to touch patho-physiological issues, such as the usefulness of PCR in the management of malaria in an endemic area or the triggering of a malaria attack in children with submicroscopic malaria.MethodsPCR data were prospectively collected in the setting of an exposed (with fever)/non exposed (without fever) study design. All children had a negative malaria rapid diagnostic test (RDT) at baseline, were followed up to day 14 and did not receive drugs with anti-malarial activity. The index group was defined by children with fever at baseline and the control group by children without fever at baseline. Children with submicroscopic malaria in these two groups were defined by a positive PCR at baseline.ResultsPCR was positive in 66 (27%) children of the index group and in 104 (44%) children of the control group respectively. The only significant factor positively related to PCR positivity at baseline was the clinical status (control group). When definition of malaria attacks included PCR results, no difference of malaria incidence was observed between the index and control groups, neither in the whole cohort, nor in children with submicroscopic malaria. The rate of undiagnosed malaria at baseline was estimated to 3.7% at baseline in the index group.ConclusionsTreating all children with fever and a positive PCR would have led to a significant increase of anti-malarial consumption, with few benefits in terms of clinical events. Non malarial fevers do not or do not frequently trigger malaria attacks in children with submicroscopic malaria.

【 授权许可】

Unknown   
© Faucher et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.