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Incidence of malaria overestimated in African children with fever
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In 2007, fewer than half of the estimated 182 million young, febrile children seen at public sector clinics in Africa were likely to be infected with Plasmodium falciparum malaria parasites and probably should not have received treatment with artemisinin combination therapy, recent study data suggest.
Health care workers in African countries generally assume that children with fever have malaria, and they immediately initiate artemisinin combination therapy, researchers from the University of Oxford in the United Kingdom said. However, they also highlighted experts’ concern about adopting this blanket policy. “This practice, which became established when diagnostic facilities for malaria were very limited, increases the chances of P. falciparum becoming resistant to [artemisinin combination therapy], wastes limited drug stocks, and means that many ill children are treated inappropriately,” the researchers wrote.
To approximate the actual incidence of malaria-related fever in children, the researchers constructed mathematical models that estimated fever prevalence among children aged 0 to 4 years and rates of those who sought treatment at public health facilities. Then, they compared this information with the disease’s epidemiology across various geographic regions to determine the percentage of febrile children who had the highest likelihood of having malaria. Data were derived from surveys and public health facility records collected from 42 African countries.
Calculations put the 2007 annual estimated prevalence of fever at 656 million for African children aged 0 to 4 years, according to the researchers, with 28% seeking treatment at public clinics. Of those, only 43% were deemed likely to be infected with P. falciparum malaria parasites. Additionally, the median number of children with fevers who visited public health facilities was 32.5% (interquartile range [IQR]=22.7-45.2).
The researchers also assessed results in terms of each location’s transmission level. The median proportion of febrile children with malarial infection was 3.3% (IQR=0.5-12) in low transmission areas, whereas this number escalated in areas with medium transmission intensity (41.5%; IQR=29-57) and high transmission intensity (59%; IQR=47-75). These data indicated the diversity in malaria incidence among various regions in Africa, they said.
The researchers said their study has important implications for the future of malaria treatment in Africa. “We estimate that 57% of the 182 million children presenting with a fever to government-supported clinics in Africa do not have a malaria infection, and in some countries that proportion is greater than 90%, highlighting the potential benefits of robust diagnosis to appropriate case management and drug-stocking levels.”
These findings may help researchers and physicians to better understand the financial and clinical resources required to implement tools such as rapid diagnostic tests that will help prevent the overuse of artemisinin combination therapy, they said.
Gething PW. PLoS Med. 2010;doi:10.1371/journal.pmed.1000301.