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The contribution of microscopy to targeting antimalarial treatment in a low transmission area of Tanzania

BACKGROUND: There is a need for improved targeting of antimalarial treatment if artemisinin combination therapy is to be successfully introduced in Africa. This study aimed to explore why malaria slides are requested and how their results guide treatment decisions in an area of low transmission of P...

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Autores principales: Reyburn, Hugh, Ruanda, John, Mwerinde, Ombeni, Drakeley, Chris
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2006
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360087/
https://www.ncbi.nlm.nih.gov/pubmed/16423307
http://dx.doi.org/10.1186/1475-2875-5-4
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author Reyburn, Hugh
Ruanda, John
Mwerinde, Ombeni
Drakeley, Chris
author_facet Reyburn, Hugh
Ruanda, John
Mwerinde, Ombeni
Drakeley, Chris
author_sort Reyburn, Hugh
collection PubMed
description BACKGROUND: There is a need for improved targeting of antimalarial treatment if artemisinin combination therapy is to be successfully introduced in Africa. This study aimed to explore why malaria slides are requested and how their results guide treatment decisions in an area of low transmission of P. falciparum. METHODS: Outpatients attending a district hospital in a highland area of Tanzania were studied over a 3-week period. Clinical and social data were collected from patients who had been prescribed an antimalarial or sent for a malaria slide. Hospital slides were re-read later by research methods. RESULTS: Of 1,273 consultations 132(10%) were treated presumptively for malaria and 214(17%) were sent for a malaria slide; only 13(6%) of these were reported positive for P. falciparum but 96(48%) of the 201 slide-negative cases were treated for malaria anyway. In a logistic regression model, adults (OR 3.86, P < 0.01), a history of fever (OR1.72, P = 0.03) and a longer travel time to the clinic (OR 1.77 per hour travelled, P < 0.01) independently predicted the request for a malaria slide. Only a history of a cough predicted (negatively) the prescription of an antimalarial with a negative slide result (OR 0.44, P < 0.01). The sensitivity and specificity of hospital slide results were 50% and 96% respectively. CONCLUSION: Progress in targeting of antimalarials in low malaria transmission settings is likely to depend on consistent use of malaria microscopy and on the willingness of health workers to be guided by negative slide results. Further studies are needed to identify how this can be achieved.
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spelling pubmed-13600872006-02-02 The contribution of microscopy to targeting antimalarial treatment in a low transmission area of Tanzania Reyburn, Hugh Ruanda, John Mwerinde, Ombeni Drakeley, Chris Malar J Research BACKGROUND: There is a need for improved targeting of antimalarial treatment if artemisinin combination therapy is to be successfully introduced in Africa. This study aimed to explore why malaria slides are requested and how their results guide treatment decisions in an area of low transmission of P. falciparum. METHODS: Outpatients attending a district hospital in a highland area of Tanzania were studied over a 3-week period. Clinical and social data were collected from patients who had been prescribed an antimalarial or sent for a malaria slide. Hospital slides were re-read later by research methods. RESULTS: Of 1,273 consultations 132(10%) were treated presumptively for malaria and 214(17%) were sent for a malaria slide; only 13(6%) of these were reported positive for P. falciparum but 96(48%) of the 201 slide-negative cases were treated for malaria anyway. In a logistic regression model, adults (OR 3.86, P < 0.01), a history of fever (OR1.72, P = 0.03) and a longer travel time to the clinic (OR 1.77 per hour travelled, P < 0.01) independently predicted the request for a malaria slide. Only a history of a cough predicted (negatively) the prescription of an antimalarial with a negative slide result (OR 0.44, P < 0.01). The sensitivity and specificity of hospital slide results were 50% and 96% respectively. CONCLUSION: Progress in targeting of antimalarials in low malaria transmission settings is likely to depend on consistent use of malaria microscopy and on the willingness of health workers to be guided by negative slide results. Further studies are needed to identify how this can be achieved. BioMed Central 2006-01-20 /pmc/articles/PMC1360087/ /pubmed/16423307 http://dx.doi.org/10.1186/1475-2875-5-4 Text en Copyright © 2006 Reyburn et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Reyburn, Hugh
Ruanda, John
Mwerinde, Ombeni
Drakeley, Chris
The contribution of microscopy to targeting antimalarial treatment in a low transmission area of Tanzania
title The contribution of microscopy to targeting antimalarial treatment in a low transmission area of Tanzania
title_full The contribution of microscopy to targeting antimalarial treatment in a low transmission area of Tanzania
title_fullStr The contribution of microscopy to targeting antimalarial treatment in a low transmission area of Tanzania
title_full_unstemmed The contribution of microscopy to targeting antimalarial treatment in a low transmission area of Tanzania
title_short The contribution of microscopy to targeting antimalarial treatment in a low transmission area of Tanzania
title_sort contribution of microscopy to targeting antimalarial treatment in a low transmission area of tanzania
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360087/
https://www.ncbi.nlm.nih.gov/pubmed/16423307
http://dx.doi.org/10.1186/1475-2875-5-4
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