Trends in fever case management for febrile inpatients in a low malaria incidence setting of Tanzania
Year: 2021
Type: article
Study design: Observational Study
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.
DOI: 10.1111/tmi.13683
Language: English
Topic: Malaria Research and Control
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: National Science Foundation, Bill and Melinda Gates Foundation, University of Otago, Research Councils UK, Department for International Development, National Institutes of Health, Directorate for Biological Sciences, Biotechnology and Biological Sciences Research Council, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases, Fogarty International Center
Awards: Viral Zoonoses and Severe Febrile Illness in Northern Tanzania, G1125710916, G1886633764, G3028693477, Vanderbilt-Emory-Cornell-Duke Consortium for Global Health Fellows (VECDor), G3168060087, G3204045353, The impact and social ecology of bacterial zoonoses in northern Tanzania, G3707093193, G396838351, Vanderbilt-Emory-Cornell-Duke Consortium for Global Health Fellows (VECDor), G4518260094, International Clinical Trials Unit, The Impact and Society Ecology of Bacterial Zoonoses in Northern Tanzania: Under, G5499729572, International Vaccine Institute - to build additional evidence to understand where typhoid vaccine is needed in Africa and accelerate its delivery where needed, Investigating Febrile Deaths in Tanzania (INDITe), G9000248948, Interdisciplinary Research Training Program in AIDS
OpenAlex ID: W3202528820