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| ANPA.ORG |
| Many Patients Unnecessarily Treated for Malaria in Sub-Saharan Africa |
| Date : - 07/11/2007 |
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Kevin L. Carter November 7, 2007 (Philadelphia) — Clinicians in sub-Saharan Africa, responding to World Health Organization (WHO) guidelines, have long been overdiagnosing malaria, especially in children aged 5 years or younger, and prescribing drugs for those who do not need them, a new study suggests. While presenting the new research here at the American Society of Tropical Medicine and Hygiene 56th Annual Meeting, Valerie D'Acremont, MD, DTM&H, said that previously accepted guidelines for malaria treatment, especially for patients 5 years of age or younger, need to be reevaluated. "This is a very controversial issue," said Dr. D'Acremont, a research physician at the Swiss Tropical Institute in Basel, Switzerland. Physicians in sub-Saharan Africa, especially eastern African nations such as Kenya, Uganda, and Tanzania, where malaria is endemic, have adhered to WHO guidelines that call on them to assume that any child 5 years of age or younger who presents with fever should be treated for malaria. But "the wasting of drugs is huge in areas of low endemicity," she said. Dr. D'Acremont and colleagues conducted a systematic review of 25 malaria diagnostic studies from 1989 to 2005, involving 15,331 patients diagnosed with malaria, performed exclusively in Africa; 11 of these studies included only patients 5 years of age or younger. The median prevalence rate (PR) of documented parasitemia among presumptive malaria patients was 29% (range, 1% – 75%), and the PR was 42% (range, 5% – 70%) in patients aged 5 years or younger. Between 1989 and 1999, the median PR was 48% (range, 5% – 75%), and after 2000, the median PR was 23% (range, 1% – 59%), signifying that malaria is indeed on the decline. As well, the advent of rapid diagnostic tests (RDTs), which detect specific antigens produced by Plasmodium falciparum and other malaria parasites in patients' blood, have significant advantages over microscopy, which has traditionally been the means through which malaria has been detected, Dr. D'Acremont said. There is also a challenge in ensuring that the RDTs are maintained and accurate. "We have the opportunity to put all of our efforts toward ensuring this," Dr. D'Acremont said in response to an inquiry about the accuracy of the malaria tests. Lawrence Barat, MD, MPH, malaria advisor to the United States Agency for International Development, told Medscape Infectious Diseases that the East African malaria-endemic nations are on the cutting edge of treatment of the disease on the continent. "The challenge is, how do we go about changing the clinical behavior?" said Dr. Barat, who attended the presentation. "Not treating everyone would represent a paradigm shift in the approach to malaria treatment in Africa." The speakers have disclosed no relevant financial relationships. American Society of Tropical Medicine and Hygiene 56th Annual Meeting: Abstract 337. Presented November 6, 2007. |
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| Reference : - www.anpa.org |
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