%0 Journal Article
%T Prescribing practice for malaria following introduction of artemether-lumefantrine in an urban area with declining endemicity in West Africa
%A Joseph U Okebe
%A Brigitte Walther
%A Kawsu Bojang
%A Silaba Drammeh
%A David Schellenberg
%A David J Conway
%A Michael Walther
%J Malaria Journal
%D 2010
%I BioMed Central
%R 10.1186/1475-2875-9-180
%X Cross-sectional surveys were carried out in two urban Gambian primary health facilities (PHFs) during and outside the malaria transmission season. Facilities were comparable in terms of the staffing compliment and capability to perform slide microscopy. Patients treated for malaria were enrolled after consultations and blood smears collected and read at a reference laboratory. Slide reading results from the PHFs were compared to the reference readings and the proportion of cases treated but with a negative test result at the reference laboratory was determined.Slide requests were made for 33.2% (173) of those enrolled, being more frequent in children (0-15 yrs) than adults during the wet season (p = 0.003). In the same period, requests were commoner in under-fives compared to older children (p = 0.022); however, a positive test result was 4.4 times more likely in the latter group (p = 0.010). Parasitaemia was confirmed for only 4.7% (10/215) and 12.5% (37/297) of patients in the dry and wet seasons, respectively. The negative predictive value of a PHF slide remained above 97% in both seasons.The study provides evidence for considerable overtreatment for malaria in a West African setting comparable to reports from areas with similar low malaria transmission in East Africa. The data suggest that laboratory facilities may be under-used, and that adherence to negative PHF slide results could significantly reduce the degree of overtreatment. The "peak prevalence" in 5-15 year olds may reflect successful implementation of malaria control interventions in under-fives, but point out the need to extend such interventions to older children.In malaria endemic areas, the lack of specific features and adequate laboratory diagnostic facilities often limits the capacity of health workers to establish a definitive diagnosis of malaria. Given the potentially lethal consequences of a missed diagnosis of malaria, case management guidelines had adopted a presumptive approach to treatme
%U http://www.malariajournal.com/content/9/1/180