Trends in fever case management for febrile inpatients in a low malaria incidence setting of Tanzania.
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2021-12
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Abstract
Objectives
In 2010, WHO published guidelines emphasising parasitological confirmation of malaria before treatment. We present data on changes in fever case management in a low malaria transmission setting of northern Tanzania after 2010.Methods
We compared diagnoses, treatments and outcomes from two hospital-based prospective cohort studies, Cohort 1 (2011-2014) and Cohort 2 (2016-2019), that enrolled febrile children and adults. All participants underwent quality-assured malaria blood smear-microscopy. Participants who were malaria smear-microscopy negative but received a diagnosis of malaria or received an antimalarial were categorised as malaria over-diagnosis and over-treatment, respectively.Results
We analysed data from 2098 participants. The median (IQR) age was 27 (3-43) years and 1047 (50.0%) were female. Malaria was detected in 23 (2.3%) participants in Cohort 1 and 42 (3.8%) in Cohort 2 (p = 0.059). Malaria over-diagnosis occurred in 334 (35.0%) participants in Cohort 1 and 190 (17.7%) in Cohort 2 (p < 0.001). Malaria over-treatment occurred in 528 (55.1%) participants in Cohort 1 and 196 (18.3%) in Cohort 2 (p < 0.001). There were 30 (3.1%) deaths in Cohort 1 and 60 (5.4%) in Cohort 2 (p = 0.007). All deaths occurred among smear-negative participants.Conclusion
We observed a substantial decline in malaria over-diagnosis and over-treatment among febrile inpatients in northern Tanzania between two time periods after 2010. Despite changes, some smear-negative participants were still diagnosed and treated for malaria. Our results highlight the need for continued monitoring of fever case management across different malaria epidemiological settings in sub-Saharan Africa.Type
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Madut, Deng B, Matthew P Rubach, John P Bonnewell, Elena R Cutting, Manuela Carugati, Nathaniel Kalengo, Michael J Maze, Anne B Morrissey, et al. (2021). Trends in fever case management for febrile inpatients in a low malaria incidence setting of Tanzania. Tropical medicine & international health : TM & IH, 26(12). pp. 1668–1676. 10.1111/tmi.13683 Retrieved from https://hdl.handle.net/10161/29833.
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Scholars@Duke
Deng Madut
I am an infectious diseases doctor who specializes in the care of patients with general infectious diseases, including persons living with HIV. My research is focused on improving the diagnosis and treatment of infectious diseases among populations living in low-resource settings.
Matthew P. Rubach
Manuela Carugati
John Andrew Crump
I am an Adjunct Professor of Medicine, Pathology, and Global Health. My work with Duke University is primarily based in northern Tanzania where I am former Site Leader and current Principal Investigator on projects linked to Duke University’s collaborative research program at Kilimanjaro Christian Medical Centre. I oversee the design and implementation of research studies on infectious diseases, particularly febrile illness, invasive bacterial disease, zoonotic infections, and infectious diseases diagnostics. In addition, I am Professor of Medicine, Pathology, and Global Health at the University of Otago and a medical epidemiologist with the US Centers for Disease Control and Prevention (CDC). My CDC work focuses on non-malaria febrile illness.
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