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Ojurongbe TA, Afolabi HA, Bashiru KA, Sule WF, Akinde SB, Ojurongbe O, Adegoke NA. Prediction of malaria positivity using patients' demographic and environmental features and clinical symptoms to complement parasitological confirmation before treatment. Trop Dis Travel Med Vaccines 2023; 9:24. [PMID: 38098124 PMCID: PMC10722830 DOI: 10.1186/s40794-023-00208-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/28/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Current malaria diagnosis methods that rely on microscopy and Histidine Rich Protein-2 (HRP2)-based rapid diagnostic tests (RDT) have drawbacks that necessitate the development of improved and complementary malaria diagnostic methods to overcome some or all these limitations. Consequently, the addition of automated detection and classification of malaria using laboratory methods can provide patients with more accurate and faster diagnosis. Therefore, this study used a machine-learning model to predict Plasmodium falciparum (Pf) antigen positivity (presence of malaria) based on sociodemographic behaviour, environment, and clinical features. METHOD Data from 200 Nigerian patients were used to develop predictive models using nested cross-validation and sequential backward feature selection (SBFS), with 80% of the dataset randomly selected for training and optimisation and the remaining 20% for testing the models. Outcomes were classified as Pf-positive or Pf-negative, corresponding to the presence or absence of malaria, respectively. RESULTS Among the three machine learning models examined, the penalised logistic regression model had the best area under the receiver operating characteristic curve for the training set (AUC = 84%; 95% confidence interval [CI]: 75-93%) and test set (AUC = 83%; 95% CI: 63-100%). Increased odds of malaria were associated with higher body weight (adjusted odds ratio (AOR) = 4.50, 95% CI: 2.27 to 8.01, p < 0.0001). Even though the association between the odds of having malaria and body temperature was not significant, patients with high body temperature had higher odds of testing positive for the Pf antigen than those who did not have high body temperature (AOR = 1.40, 95% CI: 0.99 to 1.91, p = 0.068). In addition, patients who had bushes in their surroundings (AOR = 2.60, 95% CI: 1.30 to 4.66, p = 0.006) or experienced fever (AOR = 2.10, 95% CI: 0.88 to 4.24, p = 0.099), headache (AOR = 2.07; 95% CI: 0.95 to 3.95, p = 0.068), muscle pain (AOR = 1.49; 95% CI: 0.66 to 3.39, p = 0.333), and vomiting (AOR = 2.32; 95% CI: 0.85 to 6.82, p = 0.097) were more likely to experience malaria. In contrast, decreased odds of malaria were associated with age (AOR = 0.62, 95% CI: 0.41 to 0.90, p = 0.012) and BMI (AOR = 0.47, 95% CI: 0.26 to 0.80, p = 0.006). CONCLUSION Newly developed routinely collected baseline sociodemographic, environmental, and clinical features to predict Pf antigen positivity may be a valuable tool for clinical decision-making.
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Affiliation(s)
| | | | | | | | | | - Olusola Ojurongbe
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
- Center for Emerging and Re-emerging Infectious Diseases, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Nurudeen A Adegoke
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
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2
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Kiemde F, Valia D, Kabore B, Rouamba T, Kone AN, Sawadogo S, Compaore A, Salami O, Horgan P, Moore CE, Dittrich S, Nkeramahame J, Olliaro P, Tinto H. A Randomized Trial to Assess the Impact of a Package of Diagnostic Tools and Diagnostic Algorithm on Antibiotic Prescriptions for the Management of Febrile Illnesses Among Children and Adolescents in Primary Health Facilities in Burkina Faso. Clin Infect Dis 2023; 77:S134-S144. [PMID: 37490742 PMCID: PMC10368409 DOI: 10.1093/cid/ciad331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Low- and middle-income countries face significant challenges in differentiating bacterial from viral causes of febrile illnesses, leading to inappropriate use of antibiotics. This trial aimed to evaluate the impact of an intervention package comprising diagnostic tests, a diagnostic algorithm, and a training-and-communication package on antibiotic prescriptions and clinical outcomes. METHODS Patients aged 6 months to 18 years with fever or history of fever within the past 7 days with no focus, or a suspected respiratory tract infection, arriving at 2 health facilities were randomized to either the intervention package or standard practice. The primary outcomes were the proportions of patients who recovered at day 7 (D7) and patients prescribed antibiotics at day 0. RESULTS Of 1718 patients randomized, 1681 (97.8%; intervention: 844; control: 837) completed follow-up: 99.5% recovered at D7 in the intervention arm versus 100% in standard practice (P = .135). Antibiotics were prescribed to 40.6% of patients in the intervention group versus 57.5% in the control arm (risk ratio: 29.3%; 95% CI: 21.8-36.0%; risk difference [RD]: -16.8%; 95% CI: -21.7% to -12.0%; P < .001), which translates to 1 additional antibiotic prescription saved every 6 (95% CI: 5-8) consultations. This reduction was significant regardless of test results for malaria, but was greater in patients without malaria (RD: -46.0%; -54.7% to -37.4%; P < .001), those with a respiratory diagnosis (RD: -38.2%; -43.8% to -32.6%; P < .001), and in children 6-59 months old (RD: -20.4%; -26.0% to -14.9%; P < .001). Except for the period July-September, the reduction was consistent across the other quarters (P < .001). CONCLUSIONS The implementation of the package can reduce inappropriate antibiotic prescription without compromising clinical outcomes. CLINICAL TRIALS REGISTRATION clinicaltrials.gov; NCT04081051.
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Affiliation(s)
- Francois Kiemde
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Daniel Valia
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Berenger Kabore
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Alima Nadine Kone
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Seydou Sawadogo
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Adelaide Compaore
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | | | - Philip Horgan
- FIND, Geneva, Switzerland
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- Evidence and Impact Oxford, Oxford, United Kingdom
| | - Catrin E Moore
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- Centre for Neonatal and Pediatric Infection, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | - Sabine Dittrich
- FIND, Geneva, Switzerland
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Deggendorf Institute of Technology, European Campus Rottal Inn, Pfarrkirchen, Germany
| | | | - Piero Olliaro
- FIND, Geneva, Switzerland
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
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3
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Kweku M, Der JB, Blankson WK, Salisu HM, Arizie F, Ziema SA, Gmanyami JM, Aku FY, Adjuik M. Assessment of the performance and challenges in the implementation of the test, treat and track (T3) strategy for malaria control among children under-five years in Ghana. PLoS One 2022; 17:e0278602. [PMID: 36477687 PMCID: PMC9728892 DOI: 10.1371/journal.pone.0278602] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The World Health Organization recommended the Test, Treat and Track (T3) strategy for malaria control that, every suspected malaria case should be tested prior to treatment with Artemisinin-based combination therapy (ACT) and tracked. We assessed the performance and challenges in the implementation of T3 strategy among children under-five years in Volta and Oti Regions of Ghana. METHOD A descriptive cross-sectional study was carried in 69 health facilities. Exit interviews were conducted for caregivers of children with fever using a semi-structured questionnaire. Clinicians were interviewed at the out-patient department in each facility. Descriptive statistics was conducted, Chi-square test and logistic regression were used to determine the associations between completion of T3 and independent variables. RESULTS Most children, 818/900 (90.9%) were tested for malaria and 600/818 (73.4%) were positive for malaria parasitaemia using rapid diagnostic test. Of those testing positive for malaria, 530/600 (88.3%) received treatment with ACTs. Half, (109/218) of the children testing negative for malaria also received ACTs. Also, 67/82 (81.7%) of children not tested for malaria received ACTs. Only 408/900 (45.3%) children completed T3 with Community Health-based Planning Services (CHPS) compound having the highest completion rate 202/314 (64.3%). CHPS Compounds were 6.55 times more likely to complete T3 compared to the hospitals [(95% CI: 3.77, 11.35), p<0.001]. Health facilities with laboratory services were 2.08 times more likely to complete T3 [(95% CI: 1.55, 2.79), p<0.001] The main challenge identified was clinicians' perception that RDTs do not give accurate results. CONCLUSION Testing fever cases for malaria before treatment and treating positive cases with ACTs was high. Treating negative cases and those not tested with ACTs was also high. Health facilities having laboratory services and facility being CHPS compounds were key predictors of completing T3. Clinician's not trusting RDT results can affect the T3 strategy in malaria control. Periodic training/monitoring is required to sustain adherence to the strategy.
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Affiliation(s)
- Margaret Kweku
- School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Joyce B. Der
- School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
- * E-mail:
| | - William K. Blankson
- School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Haruna M. Salisu
- School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Francis Arizie
- School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Sorengmen A. Ziema
- School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Jonathan M. Gmanyami
- School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Fortress Y. Aku
- School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Martin Adjuik
- School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
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Williams DB, Kohler JC, Howard A, Austin Z, Cheng YL. A framework for the management of donated medical devices based on perspectives of frontline public health care staff in Ghana. MEDICINE ACCESS @ POINT OF CARE 2020; 4:2399202620941367. [PMID: 36204090 PMCID: PMC9413638 DOI: 10.1177/2399202620941367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 06/15/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Transnational funders provide up to 80% of funds for medical devices in
resource-limited settings, yet sustained access to medical devices remains
unachievable. The primary goal of this study was to identify what factors
hinder access to medical devices through the perspectives of frontline
public hospital staff in Ghana involved in the implementation of
transnational funding initiatives. Methods: A case study was developed that involved an analysis of semi-structured
interviews of 57 frontline technical, clinical and administrative public
health care staff at 23 sites in Ghana between March and April 2017; a
review of the national guidelines for donations; and images of abandoned
medical devices. Results: Six key themes emerged, demonstrating how policy, collaboration, quality,
lifetime operating costs, attitudes of health care workers and
representational leadership influence access to medical devices. An in-depth
assessment of these themes has led to the development of an enterprise-wide
comprehensive acquisition and management framework for medical devices in
the context of transnational funding initiatives. Conclusion: The findings in this study underscore the importance of incorporating
frontline health care staff in developing solutions that are targeted at
improving delivery of care. Sustained access to medical devices may be
achieved in Ghana through the adoption of a rigorous and comprehensive
approach to acquisition, management and technical leadership. Funders and
public health policy makers may use the study’s findings to inform policy
reform and to ensure that the efforts of transnational funders truly help to
facilitate sustainable access to medical devices in Ghana.
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Affiliation(s)
- Dinsie B Williams
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Jillian C Kohler
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Munk School of Global Affairs, University of Toronto, Toronto, ON, Canada
- WHO Collaborating Center for Governance, Accountability and Transparency in the Pharmaceutical Sector, University of Toronto, Toronto, ON, Canada
| | - Andrew Howard
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Zubin Austin
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Yu-Ling Cheng
- Centre for Global Engineering, University of Toronto, Toronto, ON, Canada
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, ON, Canada
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5
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Ling XX, Jin JJ, Zhu GD, Wang WM, Cao YY, Yang MM, Zhou HY, Cao J, Huang JY. Cost-effectiveness analysis of malaria rapid diagnostic tests: a systematic review. Infect Dis Poverty 2019; 8:104. [PMID: 31888731 PMCID: PMC6937952 DOI: 10.1186/s40249-019-0615-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Rapid diagnostic tests (RDT) can effectively manage malaria cases and reduce excess costs brought by misdiagnosis. However, few studies have evaluated the economic value of this technology. The purpose of this study is to systematically review the economic value of RDT in malaria diagnosis. MAIN TEXT A detailed search strategy was developed to identify published economic evaluations that provide evidence regarding the cost-effectiveness of malaria RDT. Electronic databases including MEDLINE, EMBASE, Biosis Previews, Web of Science and Cochrane Library were searched from Jan 2007 to July 2018. Two researchers screened studies independently based on pre-specified inclusion and exclusion criteria. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was applied to evaluate the quality of the studies. Then cost and effectiveness data were extracted and summarized in a narrative way. Fifteen economic evaluations of RDT compared to other diagnostic methods were identified. The overall quality of studies varied greatly but most of them were scored to be of high or moderate quality. Ten of the fifteen studies reported that RDT was likely to be a cost-effective approach compared to its comparisons, but the results could be influenced by the alternatives, study perspectives, malaria prevalence, and the types of RDT. CONCLUSIONS Based on available evidence, RDT had the potential to be more cost-effective than either microscopy or presumptive diagnosis. Further research is also required to draw a more robust conclusion.
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Affiliation(s)
- Xiao-Xiao Ling
- School of Public Health, Fudan University, Key Laboratory of Health Technology Assessment, National Health Commission, Shanghai, 200032, China
| | - Jia-Jie Jin
- School of Public Health, Fudan University, Key Laboratory of Health Technology Assessment, National Health Commission, Shanghai, 200032, China
| | - Guo-Ding Zhu
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Public Health Research Centre, Jiangnan University, Wuxi, 214122, China
| | - Wei-Ming Wang
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
| | - Yuan-Yuan Cao
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
| | - Meng-Meng Yang
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
| | - Hua-Yun Zhou
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
| | - Jun Cao
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China.
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
- Public Health Research Centre, Jiangnan University, Wuxi, 214122, China.
| | - Jia-Yan Huang
- School of Public Health, Fudan University, Key Laboratory of Health Technology Assessment, National Health Commission, Shanghai, 200032, China.
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El-Houderi A, Constantin J, Castelnuovo E, Sauboin C. Economic and Resource Use Associated With Management of Malaria in Children Aged <5 Years in Sub-Saharan Africa: A Systematic Literature Review. MDM Policy Pract 2019; 4:2381468319893986. [PMID: 31903421 PMCID: PMC6927205 DOI: 10.1177/2381468319893986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 11/05/2019] [Indexed: 11/30/2022] Open
Abstract
Background. Malaria is a major health, economic, and social burden in sub-Saharan Africa. Purpose. The objective is to help understanding the economic impact of malaria and informing estimates of the potential economic impact of malaria prevention. To achieve this, we conducted a systematic review of published information on health system costs, health care resource use, and household costs for the management of malaria episodes in children aged <5 years in sub-Saharan Africa. Data Sources and Study Selection. We conducted searches in Medline, EMBASE, and Cochrane Library for studies reporting data on economic cost or resource use associated with management of malaria in children aged <5 years in sub-Saharan Africa. Searches were limited to articles published in English or French between January 1, 2006, and September 1, 2016. Conference abstracts from 2014 to 2016 were hand-searched. Data Extraction and Data Synthesis. We identified 1846 publications, of which 17 met the selection criteria. The studies covered nine countries: The Democratic Republic of Congo, Ghana, Kenya, Malawi, Mozambique, Nigeria, Tanzania, Uganda, and Zambia. All costs were standardized to 2016 US dollars (US$). Seven studies estimated the costs of a malaria episode to health systems, and 10 publications plus one abstract reported household costs. The cost to the health system was US$1.94 to US$31.53 for outpatient malaria cases to US$20 to US$136 for inpatient cases. Families bear a large share of the burden through out-of-pocket payments of medical care and lost income due to time off work. Limitations. Data were missing for many countries and few comparisons could be made. Conclusions. Severe malaria is associated with much higher costs than uncomplicated malaria, and families bear a large share of the cost burden.
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Kiemde F, Tahita MC, Lompo P, Rouamba T, Some AM, Tinto H, Mens PF, Schallig HDFH, van Hensbroek MB. Treatable causes of fever among children under five years in a seasonal malaria transmission area in Burkina Faso. Infect Dis Poverty 2018; 7:60. [PMID: 29891004 PMCID: PMC5994647 DOI: 10.1186/s40249-018-0442-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 05/17/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Fever remains a major public health problem. In Burkina Faso, more than half of febrile children are considered not to be infected by malaria. This study prospectively assessed probable (treatable) causes of fever in Burkinabe children. METHODS A prospective study was conducted among febrile children (≥37.5 °C) under 5 years of age presenting at four health facilities and one referral hospital in rural Burkina Faso. From each participant, blood was collected for malaria microscopy and culture, urine for dipstick testing and culturing if tested positive for leucocytes and nitrite, stool for rotavirus/adenovirus testing, culture and parasitology, and a nasopharyngeal swab for culture. RESULTS In total 684 febrile children were included in the study. Plasmodium falciparum malaria was found in 49.7% (340/684) of the participants and non-malaria infections in 49.1% (336/684) of children. The non-nalaria infections included gastro-intestinal infections (37.0%), common bacterial pathogens of nasopharynx (24.3%), bacterial bloodstream infections (6.0%) and urinary tract infections (1.8%). Nearly 45% (154/340) of the malaria infected children were co-infected with non-nalaria infections, but only 3.2% (11/340) of these co-infections could be considered as a possible alternative cause of fever. In contrast, in the malaria microscopy negative children 18.0% (62/344) of the infections could be the probable cause of the fever. Pathogens were not isolated from 23.7% (162/684) of the febrile cases. CONCLUSIONS Malaria remains the most common pathogen found in febrile children in Burkina Faso. However, a relative high number of febrile children had non-malaria infections. The correct diagnosis of these non-malaria fevers is a major concern, and there is an urgent need to develop more point-of-care diagnostic tests and capacities to identify and treat the causes of these fevers.
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Affiliation(s)
- Francois Kiemde
- Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso. .,Academic Medical Centre, Department of Medical Microbiology, Parasitology Unit, Amsterdam, The Netherlands. .,Global Child Health Group, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - Marc Christian Tahita
- Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Palpouguini Lompo
- Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Toussaint Rouamba
- Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Athanase M Some
- Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Halidou Tinto
- Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Petra F Mens
- Academic Medical Centre, Department of Medical Microbiology, Parasitology Unit, Amsterdam, The Netherlands
| | - Henk D F H Schallig
- Academic Medical Centre, Department of Medical Microbiology, Parasitology Unit, Amsterdam, The Netherlands
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8
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Lyimo SR, Sigalla GN, Emidi B, Mgabo MR, Kajeguka DC. Cross-sectional Survey on Antibiotic Prescription Practices Among Health Care Providers in Rombo District, Northern Tanzania. East Afr Health Res J 2018; 2:10-17. [PMID: 34308169 PMCID: PMC8279274 DOI: 10.24248/eahrj-d-18-00060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 03/08/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Irrational and inappropriate antibiotic prescription is a worldwide phenomenon – increasing the threat of serious antibiotic resistance. A better understanding of health care providers' knowledge, attitudes, and prescription practices related to antibiotics is essential for formulating effective antibiotics stewardship programmes. The aim of the present study was to assess knowledge, attitudes, and prescription practices toward antibiotics among health care providers. Methods: A descriptive cross-sectional study was conducted between March and June 2017 to assess knowledge, attitudes, and prescription practices toward antibiotics among health care providers in the Rombo district of northern Tanzania. A total of 217 health care providers were interviewed using a structured questionnaire. Results: Over half of health care providers (n=111, 51.2%) strongly agreed that the inappropriate prescription of antibiotics puts patients at risk. More than half (n=112, 51.6%) reported that their decision to start antibiotic therapy was influenced by a patient's clinical condition, while 110 (50.7%) reported they were influenced by positive microbiological results in symptomatic patients. Almost two-thirds of the health care providers (n=136, 62.7%) reported that they had access to and used antibiotic therapy guidelines. Less than a quarter (n=52, 24.0%) received regular training and education in antibiotic prescription practice in their work place. Conclusion: Knowledge and prescription practice of antibiotics among health care providers was generally unsatisfactory. Training and education for health care providers is needed in the area of prescribing antibiotics.
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Affiliation(s)
- Sarah R Lyimo
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Geoffrey N Sigalla
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Evangelical Lutheran Church in Tanzania, Arusha, Tanzania
| | - Basiliana Emidi
- National Institute for Medical Research Headquarters, Dar es Salaam, Tanzania
| | - Maseke R Mgabo
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Institute of Rural Development Planning, Dodoma, Tanzania
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Boyce MR, O'Meara WP. Use of malaria RDTs in various health contexts across sub-Saharan Africa: a systematic review. BMC Public Health 2017; 17:470. [PMID: 28521798 PMCID: PMC5437623 DOI: 10.1186/s12889-017-4398-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 05/08/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The World Health Organization recommends parasitological confirmation of malaria prior to treatment. Malaria rapid diagnostic tests (RDTs) represent one diagnostic method that is used in a variety of contexts to overcome limitations of other diagnostic techniques. Malaria RDTs increase the availability and feasibility of accurate diagnosis and may result in improved quality of care. Though RDTs are used in a variety of contexts, no studies have compared how well or effectively RDTs are used across these contexts. This review assesses the diagnostic use of RDTs in four different contexts: health facilities, the community, drug shops and schools. METHODS A comprehensive search of the Pubmed database was conducted to evaluate RDT execution, test accuracy, or adherence to test results in sub-Saharan Africa. Original RDT and Plasmodium falciparum focused studies conducted in formal health care facilities, drug shops, schools, or by CHWs between the year 2000 and December 2016 were included. Studies were excluded if they were conducted exclusively in a research laboratory setting, where staff from the study team conducted RDTs, or in settings outside of sub-Saharan Africa. RESULTS The literature search identified 757 reports. A total of 52 studies were included in the analysis. Overall, RDTs were performed safely and effectively by community health workers provided they receive proper training. Analogous information was largely absent for formal health care workers. Tests were generally accurate across contexts, except for in drug shops where lower specificities were observed. Adherence to RDT results was higher among drug shop vendors and community health workers, while adherence was more variable among formal health care workers, most notably with negative test results. CONCLUSIONS Malaria RDTs are generally used well, though compliance with test results is variable - especially in the formal health care sector. If low adherence rates are extrapolated, thousands of patients may be incorrectly diagnosed and receive inappropriate treatment resulting in a low quality of care and unnecessary drug use. Multidisciplinary research should continue to explore determinants of good RDT use, and seek to better understand how to support and sustain the correct use of this diagnostic tool.
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Affiliation(s)
| | - Wendy P O'Meara
- Duke Global Health Institute, Durham, NC, USA.,School of Public Health, Moi University College of Health Sciences, Eldoret, Kenya
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10
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Kajeguka DC, Desrochers RE, Mwangi R, Mgabo MR, Alifrangis M, Kavishe RA, Mosha FW, Kulkarni MA. Knowledge and practice regarding dengue and chikungunya: a cross-sectional study among Healthcare workers and community in Northern Tanzania. Trop Med Int Health 2017; 22:583-593. [PMID: 28294472 DOI: 10.1111/tmi.12863] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate knowledge and prevention practices regarding dengue and chikungunya amongst community members, as well as knowledge, treatment and diagnostic practices among healthcare workers. METHOD We conducted a cross-sectional survey with 125 community members and 125 healthcare workers from 13 health facilities in six villages in the Hai district of Tanzania. A knowledge score was generated based on participant responses to a structured questionnaire, with a score of 40 or higher (of 80 and 50 total scores for community members and healthcare workers, respectively) indicating good knowledge. We conducted qualitative survey (n = 40) to further assess knowledge and practice regarding dengue and chikungunya fever. RESULTS 15.2% (n = 19) of community members had good knowledge regarding dengue, whereas 53.6%, (n = 67) of healthcare workers did. 20.3% (n = 16) of participants from lowland areas and 6.5% (n = 3) from highland areas had good knowledge of dengue (χ2 = 4.25, P = 0.03). Only 2.4% (n = 3) of all participants had a good knowledge score for chikungunya. In the qualitative study, community members expressed uncertainty about dengue and chikungunya. Some healthcare workers thought that they were new diseases. CONCLUSION There is insufficient knowledge regarding dengue and chikungunya fever among community members and healthcare workers. Health promotion activities on these diseases based on Ecological Health Mode components to increase knowledge and improve preventive practices should be developed.
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Affiliation(s)
- Debora C Kajeguka
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Rose Mwangi
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Maseke R Mgabo
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Institute of Rural Development Planning, Dodoma, Tanzania
| | - Michael Alifrangis
- Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Reginald A Kavishe
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Franklin W Mosha
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Manisha A Kulkarni
- School of Epidemiology, Public Health & Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
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11
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Dinko B, Ayivor-Djanie R, Abugri J, Agboli E, Kye-Duodu G, Tagboto S, Tampuori J, Adzaku F, Binka FN, Awandare GA. Comparison of malaria diagnostic methods in four hospitals in the Volta region of Ghana. MALARIAWORLD JOURNAL 2016; 7:5. [PMID: 38601360 PMCID: PMC11003212 DOI: 10.5281/zenodo.10797112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Background Rapid diagnostic tests (RDTs) and microscopy are routinely used for the diagnosis of malaria in Ghana. DNA-based polymerase chain reaction (PCR) is not yet used routinely. We compared diagnostic methods and tested the sensitivities of different malaria diagnostic methods against PCR. Materials and methods Study participants from four hospitals with a suspicion of malaria donated finger -prick blood for RDT and blood film examination. In addition, a blood spot was collected for PCR analysis, prior to treatment. Retrospective species-specific PCR was performed on all samples collected. Results Using PCR we found an overall malaria prevalence of 39% among the 211 evaluable blood spots (83/211) and this ranged between 6-61% across the four hospitals. Of the 164 participants with RDT data, malaria prevalence was 57% (94/164), ranging from 3-100% from the four hospitals. Microscopy was the least sensitive with a parasite prevalence of 21% (25/119) of the evaluable 119 participants, varying from 9 to 35% across three health facilities. By comparison, we found the sensitivities and specificities of RDT results when compared to PCR to be slightly higher than microscopy compared to PCR. These were 56.4% versus 41.7% and 90% versus 81.9%, respectively, but generally lower than expected. Ninety-five percent of the PCR-detected infections were P. falciparum, while 4% were mixed species infections of P. falciparum and P. malariae, with the remaining being a mono-infection of P. malariae. Conclusions While using PCR as a gold standard, we found RDT to be more reliable in diagnosing malaria than microscopy. In addition, a majority of malaria-treated cases were not supported by PCR diagnosis, leading to possible overtreatment. Pragmatic strategies are needed to ensure suspected malaria cases are accurately diagnosed before treatment.
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Affiliation(s)
- Bismarck Dinko
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Reuben Ayivor-Djanie
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - James Abugri
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Accra, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Accra, Ghana
| | - Eric Agboli
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Gideon Kye-Duodu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Senyo Tagboto
- Department of Internal Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - John Tampuori
- Department of Urology, Volta Regional Hospital, Ho, Ghana
| | - Festus Adzaku
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Fred N Binka
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Gordon A Awandare
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Accra, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Accra, Ghana
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12
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Abokyi LN, Asante KP, Mahama E, Gyaase S, Sulemana A, Kwarteng A, Ayaam J, Dosoo D, Adu-Gyasi D, Amenga Etego S, Ogutu B, Akweongo P, Owusu-Agyei S. Use of Antimalarial in the Management of Fever during a Community Survey in the Kintampo Districts of Ghana. PLoS One 2015; 10:e0142106. [PMID: 26580076 PMCID: PMC4651568 DOI: 10.1371/journal.pone.0142106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 10/16/2015] [Indexed: 11/18/2022] Open
Abstract
Background Epidemiology of malaria and related fevers in most parts of Africa is changing due to scale up of interventions such as appropriate use of ACTs in the effort towards sustained control and eventual elimination of malaria. The use of ACTs in the management of malaria-associated fever was evaluated in the Kintampo districts of Ghana. Methods Household survey was conducted between October 2009 and February, 2011. A random selection of 370 households was generated from 25,000 households existing within the Health and Demographic Surveillance Systems in Kintampo, Ghana at the time. All household members present at the time of survey in the eligible households were interviewed based on a two weeks reported fever recall and the use of antimalarial for the management of fever. A finger-prick blood sample was also obtained from each member of the household present and later examined for malaria parasites using microscopy. Descriptive analysis was performed, with univariate and multivariate analysis used to identify predictors of fever and malaria parasitemia. Results A total of 1436 individuals were interviewed from 370 households. Overall, fever prevalence was 23.8% (341/1436) and was 38.8% (77/198) in children < 5 years, 21.3% (264/1238) in older children plus adults. Participants who sought treatment for fever were 84% (285/341) with 47.7% (136/285) using any anti-malarial. Artemisinin-based Combination Therapy use was in 69.1% (94/136) of cases while 30.9% used mono-therapies. Malaria parasitaemia rate was 28.2% (397/1407). Conclusion The study reports high community fever prevalence, frequent use of antimalarials for fever treatment and relatively high use of mono-therapies especially in children < 5 years in an area with high malaria parasite prevalence in Ghana.
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Affiliation(s)
- Livesy Naafoe Abokyi
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
- * E-mail:
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Emmanuel Mahama
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Stephaney Gyaase
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Abubakari Sulemana
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Anthony Kwarteng
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Jennifer Ayaam
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - David Dosoo
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Dennis Adu-Gyasi
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Seeba Amenga Etego
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Bernhards Ogutu
- INDEPTH Network, East Legon, P.O. Box KD 213 Kanda, Accra, Ghana
| | - Patricia Akweongo
- School of Public Health, College of Health Sciences, PO Box LG-13, Legon, Accra, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
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13
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Parham PE, Hughes DA. Climate influences on the cost-effectiveness of vector-based interventions against malaria in elimination scenarios. Philos Trans R Soc Lond B Biol Sci 2015; 370:rstb.2013.0557. [PMID: 25688017 DOI: 10.1098/rstb.2013.0557] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Despite the dependence of mosquito population dynamics on environmental conditions, the associated impact of climate and climate change on present and future malaria remains an area of ongoing debate and uncertainty. Here, we develop a novel integration of mosquito, transmission and economic modelling to assess whether the cost-effectiveness of indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) against Plasmodium falciparum transmission by Anopheles gambiae s.s. mosquitoes depends on climatic conditions in low endemicity scenarios. We find that although temperature and rainfall affect the cost-effectiveness of IRS and/or LLIN scale-up, whether this is sufficient to influence policy depends on local endemicity, existing interventions, host immune response to infection and the emergence rate of insecticide resistance. For the scenarios considered, IRS is found to be more cost-effective than LLINs for the same level of scale-up, and both are more cost-effective at lower mean precipitation and higher variability in precipitation and temperature. We also find that the dependence of peak transmission on mean temperature translates into optimal temperatures for vector-based intervention cost-effectiveness. Further cost-effectiveness analysis that accounts for country-specific epidemiological and environmental heterogeneities is required to assess optimal intervention scale-up for elimination and better understand future transmission trends under climate change.
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Affiliation(s)
- Paul E Parham
- Department of Public Health and Policy, University of Liverpool, London, EC2A 1AG, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, LL57 2PZ, UK
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14
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Febir LG, Baiden FE, Agula J, Delimini RK, Akpalu B, Tivura M, Amanfo N, Chandramohan D, Owusu-Agyei S, Webster J. Implementation of the integrated management of childhood illness with parasitological diagnosis of malaria in rural Ghana: health worker perceptions. Malar J 2015; 14:174. [PMID: 25899509 PMCID: PMC4430025 DOI: 10.1186/s12936-015-0699-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Timely and appropriate management of febrile illness among children under five years of age will contribute to achieving Millennium Development Goal-4. The revised World Health Organization-Global Malaria Programme's policy on test-based management of malaria must integrate effectively into the Integrated Management of Childhood Illness (IMCI). This study reports on perceptions of health workers on the health system factors influencing effective delivery of test-based diagnosis of malaria with IMCI. METHODS A qualitative study was conducted among a range of health workers at different levels of the health system in the Brong Ahafo Region of Ghana. Interview transcripts were transferred into Nvivo 8 software for data management and analysis. A frame-work approach at two levels was used in the analysis, which included the processes required for implementation of test-based management of malaria and the health systems context. RESULTS Forty-nine in-depth interviews were conducted. The National Health Insurance Scheme (NHIS) was perceived to have led to an increase in health facility attendance, thereby increasing the workload of health workers. Workload was reported as the main reason that health workers were not able to complete all of the examinations included in the IMCI algorithm. The NHIS financing guidelines were seen to be determining diagnosis and treatment practices by health-care givers. Concern was expressed about the erratic supply of malaria rapid diagnostic test kits (RDTs), the quality of RDTs related to potential false negative results when clinical symptoms were consistent with malaria. IMCI was seen as important but practically impossible to fully implement due to workload. CONCLUSIONS Implementation of the WHO-revised IMCI guideline is confronted with a myriad of health systems challenges. The perceptions of front-line health workers on the accuracy and need for RDTs together with the capacity of health systems to support implementation plays a crucial role. The NHIS financing guidelines of diagnostics and treatments are influencing clinical decision-making in this setting. Further study is needed to understand the impact of the NHIS on the feasibility of integrating test-based management for malaria into the IMCI guidelines.
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Affiliation(s)
| | - Frank E Baiden
- Epidemiology Unit, Ensign College of Public Health, Kpong, Eastern Region, Ghana.
| | - Justina Agula
- National Catholic Health Service, Project Fives Alive Christian Village KS 99, Kumasi, Ashanti Region, Ghana.
| | | | - Bright Akpalu
- University of Health and Allied Sciences, Ho, Ghana.
| | - Mathilda Tivura
- Kintampo Health Research Centre, PO Box 200, Kintampo, Ghana.
| | - Nelson Amanfo
- Kintampo Health Research Centre, PO Box 200, Kintampo, Ghana.
| | - Daniel Chandramohan
- Disease Control Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | | | - Jayne Webster
- Disease Control Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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15
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Onchiri FM, Pavlinac PB, Singa BO, Naulikha JM, Odundo EA, Farquhar C, Richardson BA, John-Stewart G, Walson JL. Frequency and correlates of malaria over-treatment in areas of differing malaria transmission: a cross-sectional study in rural Western Kenya. Malar J 2015; 14:97. [PMID: 25890202 PMCID: PMC4349314 DOI: 10.1186/s12936-015-0613-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 02/13/2015] [Indexed: 11/24/2022] Open
Abstract
Background In 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. Methods Between 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. Results Among 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). Conclusions Malaria 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.
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Affiliation(s)
- Frankline M Onchiri
- Department of Epidemiology, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA. .,Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya.
| | - Patricia B Pavlinac
- Department of Epidemiology, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA.
| | - Benson O Singa
- Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya.
| | - Jacqueline M Naulikha
- Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya. .,Department of Pediatrics, University of Washington, Seattle, USA.
| | - Elizabeth A Odundo
- Walter Reed Project, United States Army Medical Research Unit, Kericho, Kenya.
| | - Carey Farquhar
- Department of Epidemiology, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA. .,Department of Global Health, University of Washington, Seattle, USA. .,Department of Medicine, University of Washington, Seattle, USA.
| | - Barbra A Richardson
- 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.
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, 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.
| | - Judd L Walson
- Department of Epidemiology, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, 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.
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16
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Mpimbaza A, Miles M, Sserwanga A, Kigozi R, Wanzira H, Rubahika D, Nasr S, Kapella BK, Yoon SS, Chang M, Yeka A, Staedke SG, Kamya MR, Dorsey G. Comparison of routine health management information system versus enhanced inpatient malaria surveillance for estimating the burden of malaria among children admitted to four hospitals in Uganda. Am J Trop Med Hyg 2014; 92:18-21. [PMID: 25422396 DOI: 10.4269/ajtmh.14-0284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The primary source of malaria surveillance data in Uganda is the Health Management Information System (HMIS), which does not require laboratory confirmation of reported malaria cases. To improve data quality, an enhanced inpatient malaria surveillance system (EIMSS) was implemented with emphasis on malaria testing of all children admitted in select hospitals. Data were compared between the HMIS and the EIMSS at four hospitals over a period of 12 months. After the implementation of the EIMSS, over 96% of admitted children under 5 years of age underwent laboratory testing for malaria. The HMIS significantly overreported the proportion of children under 5 years of age admitted with malaria (average absolute difference = 19%, range = 8-27% across the four hospitals) compared with the EIMSS. To improve the quality of the HMIS data for malaria surveillance, the National Malaria Control Program should, in addition to increasing malaria testing rates, focus on linking laboratory test results to reported malaria cases.
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Affiliation(s)
- Arthur Mpimbaza
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Program, Ministry of Health Uganda, Kampala, Uganda; US President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California
| | - Melody Miles
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Program, Ministry of Health Uganda, Kampala, Uganda; US President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California
| | - Asadu Sserwanga
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Program, Ministry of Health Uganda, Kampala, Uganda; US President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California
| | - Ruth Kigozi
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Program, Ministry of Health Uganda, Kampala, Uganda; US President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California
| | - Humphrey Wanzira
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Program, Ministry of Health Uganda, Kampala, Uganda; US President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California
| | - Denis Rubahika
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Program, Ministry of Health Uganda, Kampala, Uganda; US President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California
| | - Sussann Nasr
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Program, Ministry of Health Uganda, Kampala, Uganda; US President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California
| | - Bryan K Kapella
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Program, Ministry of Health Uganda, Kampala, Uganda; US President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California
| | - Steven S Yoon
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Program, Ministry of Health Uganda, Kampala, Uganda; US President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California
| | - Michelle Chang
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Program, Ministry of Health Uganda, Kampala, Uganda; US President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California
| | - Adoke Yeka
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Program, Ministry of Health Uganda, Kampala, Uganda; US President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California
| | - Sarah G Staedke
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Program, Ministry of Health Uganda, Kampala, Uganda; US President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California
| | - Moses R Kamya
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Program, Ministry of Health Uganda, Kampala, Uganda; US President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California
| | - Grant Dorsey
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; National Malaria Control Program, Ministry of Health Uganda, Kampala, Uganda; US President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California
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Mahende C, Ngasala B, Lusingu J, Butichi A, Lushino P, Lemnge M, Premji Z. Aetiology of acute febrile episodes in children attending Korogwe District Hospital in north-eastern Tanzania. PLoS One 2014; 9:e104197. [PMID: 25090651 PMCID: PMC4121319 DOI: 10.1371/journal.pone.0104197] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/11/2014] [Indexed: 12/24/2022] Open
Abstract
Introduction Although the burden of malaria in many parts of Tanzania has declined, the proportion of children with fever has not changed. This situation underscores the need to explore the possible causes of febrile episodes in patients presenting with symptoms at the Korogwe District Hospital (KDH). Methods A hospital based cross-sectional study was conducted at KDH, north-eastern Tanzania. Patients aged 2 to 59 months presenting at the outpatient department with an acute medical condition and fever (measured axillary temperature ≥37.5°C) were enrolled. Blood samples were examined for malaria parasites, human immunodeficiency virus (HIV) and bacterial infections. A urine culture was performed in selected cases to test for bacterial infection and a chest radiograph was requested if pneumonia was suspected. Diagnosis was based on both clinical and laboratory investigations. Results A total of 867 patients with a median age of 15.1 months (Interquartile range 8.6–29.9) were enrolled from January 2013 to October 2013. Respiratory tract infections were the leading clinical diagnosis with 406/867 (46.8%) of patients diagnosed with upper respiratory tract infection and 130/867 (15.0%) with pneumonia. Gastroenteritis was diagnosed in 184/867 (21.2%) of patients. Malaria infection was confirmed in 72/867 (8.3%) of patients. Bacterial infection in blood and urine accounted for 26/808 (3.2%) infections in the former, and 66/373 (17.7%) infections in the latter. HIV infection was confirmed in 10/824 (1.2%) of patients. Respiratory tract infections and gastroenteritis were frequent in patients under 36 months of age (87.3% and 91.3% respectively). Co-infections were seen in 221/867 (25.5%) of patients. The cause of fever was not identified in 65/867 (7.5%) of these patients. Conclusions The different proportions of infections found among febrile children reflect the causes of fever in the study area. These findings indicate the need to optimise patient management by developing malaria and non-malaria febrile illnesses management protocols.
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Affiliation(s)
- Coline Mahende
- Korogwe Research Laboratory, National Institute for Medical Research, Tanga, Tanzania
- Department of Medical Entomology and Parasitology, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- * E-mail:
| | - Billy Ngasala
- Department of Medical Entomology and Parasitology, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - John Lusingu
- Korogwe Research Laboratory, National Institute for Medical Research, Tanga, Tanzania
| | - Allvan Butichi
- Korogwe Research Laboratory, National Institute for Medical Research, Tanga, Tanzania
| | - Paminus Lushino
- Korogwe Research Laboratory, National Institute for Medical Research, Tanga, Tanzania
| | - Martha Lemnge
- Korogwe Research Laboratory, National Institute for Medical Research, Tanga, Tanzania
| | - Zul Premji
- Department of Medical Entomology and Parasitology, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Abreha T, Alemayehu B, Tadesse Y, Gebresillassie S, Tadesse A, Demeke L, Zewde F, Habtamu M, Tadesse M, Yadeta D, Teshome D, Mekasha A, Gobena K, Bogale H, Melaku Z, Reithinger R, Teka H. Malaria diagnostic capacity in health facilities in Ethiopia. Malar J 2014; 13:292. [PMID: 25073561 PMCID: PMC4237856 DOI: 10.1186/1475-2875-13-292] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 07/16/2014] [Indexed: 12/02/2022] Open
Abstract
Background Accurate early diagnosis and prompt treatment is one of the key strategies to control and prevent malaria in Ethiopia where both Plasmodium falciparum and Plasmodium vivax are sympatric and require different treatment regimens. Microscopy is the standard for malaria diagnosis at the health centres and hospitals whereas rapid diagnostic tests are used at community-level health posts. The current study was designed to assess malaria microscopy capacity of health facilities in Oromia Regional State and Dire Dawa Administrative City, Ethiopia. Methods A descriptive cross-sectional study was conducted from February to April 2011 in 122 health facilities, where health professionals were interviewed using a pre-tested, standardized assessment tool and facilities’ laboratory practices were assessed by direct observation. Results Of the 122 assessed facilities, 104 (85%) were health centres and 18 (15%) were hospitals. Out of 94 health facilities reportedly performing blood films, only 34 (36%) used both thin and thick smears for malaria diagnosis. The quality of stained slides was graded in 66 health facilities as excellent, good and poor quality in 11(17%), 31 (47%) and 24 (36%) respectively. Quality assurance guidelines and malaria microscopy standard operating procedures were found in only 13 (11%) facilities and 12 (10%) had involved in external quality assessment activities, and 32 (26%) had supportive supervision within six months of the survey. Only seven (6%) facilities reported at least one staff’s participation in malaria microscopy refresher training during the previous 12 months. Although most facilities, 96 (79%), had binocular microscopes, only eight (7%) had the necessary reagents and supplies to perform malaria microscopy. Treatment guidelines for malaria were available in only 38 (31%) of the surveyed facilities. Febrile patients with negative malaria laboratory test results were managed with artemether-lumefantrine or chloroquine in 51% (53/104) of assessed health facilities. Conclusions The current study indicated that most of the health facilities had basic infrastructure and equipment to perform malaria laboratory diagnosis but with significant gaps in continuous laboratory supplies and reagents, and lack of training and supportive supervision. Overcoming these gaps will be critical to ensure that malaria laboratory diagnosis is of high-quality for better patient management.
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