Evaluation of in-hospital management for febrile illness in Northern Tanzania before and after 2010 World Health Organization Guidelines for the treatment of malaria.

Moon, Andrew M

Biggs, Holly M

Rubach, Matthew P

Crump, John A

Maro, Venace P

Saganda, Wilbrod

Reddy, Elizabeth A

Jones, Caroline OH

United States

2017-03-02T19:10:39Z

2017-03-02T19:10:39Z

2014

OBJECTIVE: In 2010, the World Health Organization (WHO) published updated guidelines emphasizing and expanding recommendations for a parasitological confirmation of malaria before treating with antimalarials. This study aimed to assess differences in historic (2007-2008) (cohort 1) and recent (2011-2012) (cohort 2) hospital cohorts in the diagnosis and treatment of febrile illness in a low malaria prevalence area of northern Tanzania. MATERIALS AND METHODS: We analyzed data from two prospective cohort studies that enrolled febrile adolescents and adults aged ≥13 years. All patients received quality-controlled aerobic blood cultures and malaria smears. We compared patients' discharge diagnoses, treatments, and outcomes to assess changes in the treatment of malaria and bacterial infections. RESULTS: In total, 595 febrile inpatients were enrolled from two referral hospitals in Moshi, Tanzania. Laboratory-confirmed malaria was detected in 13 (3.2%) of 402 patients in cohort 1 and 1 (0.5%) of 193 patients in cohort 2 (p = 0.041). Antimalarials were prescribed to 201 (51.7%) of 389 smear-negative patients in cohort 1 and 97 (50.5%) of 192 smear-negative patients in cohort 2 (p = 0.794). Bacteremia was diagnosed from standard blood culture in 58 (14.5%) of 401 patients in cohort 1 compared to 18 (9.5%) of 190 patients in cohort 2 (p = 0.091). In cohort 1, 40 (69.0%) of 58 patients with a positive blood culture received antibacterials compared to 16 (88.9%) of 18 patients in cohort 2 (p = 0.094). In cohort 1, 43 (10.8%) of the 399 patients with known outcomes died during hospitalization compared with 12 (6.2%) deaths among 193 patients in cohort 2 (p = 0.073). DISCUSSION: In a setting of low malaria transmission, a high proportion of smear-negative patients were diagnosed with malaria and treated with antimalarials despite updated WHO guidelines on malaria treatment. Improved laboratory diagnostics for non-malaria febrile illness might help to curb this practice.

https://www.ncbi.nlm.nih.gov/pubmed/24587056

PONE-D-13-35569

1932-6203

https://hdl.handle.net/10161/13775

eng

Public Library of Science (PLoS)

PLoS One

10.1371/journal.pone.0089814

Adolescent

Adult

Antimalarials

Cohort Studies

Diagnosis, Differential

Fever

Guideline Adherence

Humans

Malaria

Prospective Studies

Tanzania

Treatment Outcome

World Health Organization

Evaluation of in-hospital management for febrile illness in Northern Tanzania before and after 2010 World Health Organization Guidelines for the treatment of malaria.

Journal article

https://www.ncbi.nlm.nih.gov/pubmed/24587056

e89814

2

Clinical Science Departments

Duke

Global Health Institute

Institutes and Provost's Academic Units

Medicine

Medicine, Infectious Diseases

Pathology

School of Medicine

University Institutes and Centers

Published online

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