Presumptive Treatment of Malaria in Ghana: Was It Ever Useful? Evidence from the Kassena-Nankana District of Northern Ghana

BACKGROUND: The WHO currently advocates parasitological confirmation of malaria before treatment is commenced. However, many arguments have emerged both for and against this new position. To contribute to the debate, this secondary data analysis was conducted to determine the likelihood of malaria parasitaemia in a child presenting with fever, vomiting, or cough in the Kassena-Nankana District. METHODS: The dataset for this analysis was generated during a study to assess the incidence and risk factors for paediatric rotavirus diarrhoea in the Kassena-Nankana District. Over a two-year period, trained field staff recruited 2086 subjects with episodes of diarrhoea aged 24 months or below into the study. A standard case report form was used to collect data on histories of illness, symptoms, vaccination, and anthropometry. Blood smears were tested for malaria parasites. The data set generated was obtained, cleaned, and analysed using Epi Info version 7.1.1.14 statistical software. RESULTS: Of the 2086 subjects recruited, 2078 had blood smears done and 54.0% had malaria parasites. Fever and vomiting appeared to be associated with parasitaemia with odds ratios of 1.9 (95% CI: 1.5586–2.2370) and 1.2 (95% CI: 1.0352–1.4697), respectively. Cough however appeared protective with an odds ratio of 0.8 (95% CI: 0.6910–0.9765). The odds of parasitaemia appeared to increase where a child presented with more than one symptom. CONCLUSION: Nearly half (46%) of the subjects in this study presented with symptoms but had no malaria. Presumptive treatment of malaria may therefore be useful in situations where diagnostic tests are not readily available, its routine practice should however not be encouraged.