Background: Diagnosis of severe malaria by microscopy can be challenging in children who have previously received presumptive antimalarial treatment. Objective: To analyse the value of rapid diagnostic tests (RDTs) in the diagnosis and management of severe malaria in children who have received incomplete presumptive antimalarial treatment prior to admission. Methods: This was a prospective study which was carried out from December 2021 to April 2022 in the paediatric intensive care unit. Children admitted with suspected severe malaria and who had received incomplete presumptive antimalarial treatment prior to admission were included exhaustively. Microscopic examination of blood smears and RDTs was performed on all children. The p-value was set at 5% and the confidence interval at 95%. Results: In total, 97 (66.0%) of the 147 children admitted for suspected severe malaria met the inclusion criteria, including 49 (50.5%) girls. The median age was 48 months [IQR: 33.5 - 100.5]. The number of confirmed cases of severe malaria by TBS was 26 (26.8%) versus 84 (86.6%) by RDTs (p < 0.0001; OR 17.6 [8.4 - 36.9]). The RDTs helped prevent the misuse of antimalarials in 13.4% of the children. Conclusion: The irrational use of antimalarial drugs remains common, making it difficult to diagnose severe malaria by microscopy. In these conditions, malaria RDTs can provide a reasonable alternative for better case identification.
References
[1]
WHO (2024) Paludisme. https://www.who.int/fr/news-room/fact-sheets/detail/malaria
[2]
Ministère de la santé et de la population (2021) Plan stratégique intégré de la santé de la reproduction maternelle, Néonatale, Infantile, Des adolescents et la nutrition du Congo (PSI SRMNIA) 2022-2026. République du Congo.
[3]
Moyen, G., Mbika Cardorelle, A., Kambourou, J., Oko, A.P.G., Mouko, A. and Obengui. (2010) Paludisme grave de l’enfant à Brazzaville. Médecine d’Afrique noire, 57, 113-116.
[4]
Faced with “Clear Science, Real Threats,” Countries Must Remain Committed to Paris Climate Deal. https://www.un.org/sustainabledevelopment/f
[5]
World Health Organization (WHO) (2015) Guidelines for Treatment of Malaria. 3rd Edition, World Health Organization.
[6]
World Health Organization (WHO) (2010) Guidelines for the Treatment of Malaria. 2nd Edition, World Health Organization, 1-194.
[7]
Wongsrichanalai, C., Barcus, M.J., Muth, S., Sutamihardja, A. and Wernsdorfer, W.H. (2007) A Review of Malaria Diagnostic Tools: Microscopy and Rapid Diagnostic Test (rdt). TheAmericanJournalofTropicalMedicineandHygiene, 77, 119-127. https://doi.org/10.4269/ajtmh.2007.77.119
[8]
WHO (2018) Malaria Rapid Diagnostic Test Performance—Summary Results of WHO Product Testing of Malaria RDTs: Rounds 1-8 (2008-2018). World Health Organization.
[9]
Abba, K., Deeks, J.J., Olliaro, P.L., Naing, C., Jackson, S.M., Takwoingi, Y., et al. (2011) Rapid Diagnostic Tests for Diagnosing Uncomplicated P.falciparum Malaria in Endemic Countries. CochraneDatabaseofSystematicReviews, No. 7, CD008122. https://doi.org/10.1002/14651858.cd008122.pub2
[10]
Hendriksen, I.C.E., Mtove, G., Pedro, A.J., Gomes, E., Silamut, K., Lee, S.J., et al. (2011) Evaluation of a PfHRP2 and a pLDH-Based Rapid Diagnostic Test for the Diagnosis of Severe Malaria in 2 Populations of African Children. ClinicalInfectiousDiseases, 52, 1100-1107. https://doi.org/10.1093/cid/cir143
[11]
Feleke, D.G., Alemu, Y. and Yemanebirhane, N. (2021) Performance of Rapid Diagnostic Tests, Microscopy, Loop-Mediated Isothermal Amplification (LAMP) and PCR for Malaria Diagnosis in Ethiopia: A Systematic Review and Meta-Analysis. MalariaJournal, 20, Article No. 384. https://doi.org/10.1186/s12936-021-03923-8
[12]
Reyburn, H., Ruanda, J., Mwerinde, O. and Drakeley, C. (2006) The Contribution of Microscopy to Targeting Antimalarial Treatment in a Low Transmission Area of Tanzania. MalariaJournal, 5, Article No. 4. https://doi.org/10.1186/1475-2875-5-4
[13]
Bilal, J.A., Gasim, G.I., Abdien, M.T., Elmardi, K.A., Malik, E.M. and Adam, I. (2015) Poor Adherence to the Malaria Management Protocol among Health Workers Attending Under-Five Year Old Febrile Children at Omdurman Hospital, Sudan. MalariaJournal, 14, Article No. 34. https://doi.org/10.1186/s12936-015-0575-9
[14]
Omache, D., Owuor, N. and Machini, B. (2020) Predictors of Presumptive Treatment of Uncomplicated Malaria among Children in Private Retail Outlets in Kenya: Mixed Effects Logistic Regression Modelling. F1000Research, 9, Article 1059. https://doi.org/10.12688/f1000research.25603.1
[15]
World Health Organization (2006) WHO Briefing on Malaria Treatment Guidelines and Artemisinin Monotherapies. World Health Organization.
[16]
Ilunga-Ilunga, F., Leveque, A., Donnen, P. and Dramaix, M. (2015) Caractéristiques des ménages des enfants hospitalisés pour paludisme grave et facteurs associés à la létalité palustre à Kinshasa (République démocratique du Congo). Médecine et Santé Tropicales, 25, 75-81.
[17]
Guinovart, C., Sigaúque, B., Bassat, Q., Loscertales, M.P., Nhampossa, T., Acácio, S., et al. (2022) The Epidemiology of Severe Malaria at Manhiça District Hospital, Mozambique: A Retrospective Analysis of 20 Years of Malaria Admissions Surveillance Data. TheLancetGlobalHealth, 10, e873-e881. https://doi.org/10.1016/s2214-109x(22)00125-5
[18]
Okoko, A.R., Angouma Oya, S.M., Moyen, E., Kambourou, J., Ekouya-Bowassa, G., Atanda, H.L., et al. (2016) Paludisme grave de l’enfant au Centre Hospitalier et Universitaire de Brazzaville. JournaldePédiatrieetdePuériculture, 29, 304-309. https://doi.org/10.1016/j.jpp.2016.09.004
[19]
Falade, C.O., Orimadegun, A.E., Michael, O.S., Dada‐Adegbola, H.O., Ogunkunle, O.O., Badejo, J.A., et al. (2019) Consequences of Restricting Antimalarial Drugs to Rapid Diagnostic Test‐Positive Febrile Children in South-West Nigeria. TropicalMedicine&InternationalHealth, 24, 1291-1300. https://doi.org/10.1111/tmi.13304
