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Prevalence and Clinical Management of Non-malarial Febrile Illnesses among Outpatients in the Era of Universal Malaria Testing in Malawi.
Am J Trop Med Hyg. 2020 Aug; 103(2):887-893.AJ

Abstract

Increasing access to rapid diagnostic tests for malaria (mRDTs) has raised awareness of the challenges healthcare workers face in managing non-malarial febrile illnesses (NMFIs). We examined NMFI prevalence, clinical diagnoses, and prescribing practices in outpatient clinics across different malaria transmission settings in Malawi. Standardized facility-based malaria surveillance was conducted at three facilities one of every 4 weeks over 2 years. Information on demographics, presenting symptoms, temperature, clinical diagnosis, and treatment were collected from outpatients presenting with malaria-like symptoms. Of the 25,486 patients with fever, 69% had NMFI. Non-malarial febrile illness prevalence was lower in 5- to 15-year-old patients (55%) than in children < 5 years (72%) and adults > 15 years of age (77%). The most common clinical diagnoses among febrile patients with negative mRDTs in all age-groups and settings were respiratory infections (46%), sepsis (29%), gastroenteritis (13%), musculoskeletal pain (9%), and malaria (5%). Antibiotic prescribing was high in all age-groups and settings. Trimethoprim-sulfamethoxazole (40%) and amoxicillin (29%) were the most commonly prescribed antibiotics and were used for nearly all clinical diagnoses. In these settings with minimal access to diagnostic tools, patients with fever and a negative mRDT received a limited number of clinical diagnoses. Many were likely to be inaccurate and were associated with the inappropriate use of the limited range of available antibiotics. Prescription and diagnostic practices for NMFIs in the facilities require research and policy input. Resource-limited malaria-endemic countries urgently need more point-of-care diagnostic tools and evidence-based diagnosis and treatment algorithms to provide effective and cost-efficient care.

Authors+Show Affiliations

Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi.Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi.Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi.Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi.Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi.Malawi National Malaria Control Program, Lilongwe, Malawi.Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts.College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan. Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi.Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32588795

Citation

Kapito-Tembo, Atupele, et al. "Prevalence and Clinical Management of Non-malarial Febrile Illnesses Among Outpatients in the Era of Universal Malaria Testing in Malawi." The American Journal of Tropical Medicine and Hygiene, vol. 103, no. 2, 2020, pp. 887-893.
Kapito-Tembo A, Mathanga D, Bauleni A, et al. Prevalence and Clinical Management of Non-malarial Febrile Illnesses among Outpatients in the Era of Universal Malaria Testing in Malawi. Am J Trop Med Hyg. 2020;103(2):887-893.
Kapito-Tembo, A., Mathanga, D., Bauleni, A., Nyirenda, O., Pensulo, P., Ali, D., Valim, C., Taylor, T. E., & Laufer, M. K. (2020). Prevalence and Clinical Management of Non-malarial Febrile Illnesses among Outpatients in the Era of Universal Malaria Testing in Malawi. The American Journal of Tropical Medicine and Hygiene, 103(2), 887-893. https://doi.org/10.4269/ajtmh.18-0800
Kapito-Tembo A, et al. Prevalence and Clinical Management of Non-malarial Febrile Illnesses Among Outpatients in the Era of Universal Malaria Testing in Malawi. Am J Trop Med Hyg. 2020;103(2):887-893. PubMed PMID: 32588795.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence and Clinical Management of Non-malarial Febrile Illnesses among Outpatients in the Era of Universal Malaria Testing in Malawi. AU - Kapito-Tembo,Atupele, AU - Mathanga,Don, AU - Bauleni,Andrew, AU - Nyirenda,Osward, AU - Pensulo,Paul, AU - Ali,Doreen, AU - Valim,Clarissa, AU - Taylor,Terrie E, AU - Laufer,Miriam K, Y1 - 2020/06/18/ PY - 2021/08/01/pmc-release PY - 2020/6/27/pubmed PY - 2020/6/27/medline PY - 2020/6/27/entrez SP - 887 EP - 893 JF - The American journal of tropical medicine and hygiene JO - Am. J. Trop. Med. Hyg. VL - 103 IS - 2 N2 - Increasing access to rapid diagnostic tests for malaria (mRDTs) has raised awareness of the challenges healthcare workers face in managing non-malarial febrile illnesses (NMFIs). We examined NMFI prevalence, clinical diagnoses, and prescribing practices in outpatient clinics across different malaria transmission settings in Malawi. Standardized facility-based malaria surveillance was conducted at three facilities one of every 4 weeks over 2 years. Information on demographics, presenting symptoms, temperature, clinical diagnosis, and treatment were collected from outpatients presenting with malaria-like symptoms. Of the 25,486 patients with fever, 69% had NMFI. Non-malarial febrile illness prevalence was lower in 5- to 15-year-old patients (55%) than in children < 5 years (72%) and adults > 15 years of age (77%). The most common clinical diagnoses among febrile patients with negative mRDTs in all age-groups and settings were respiratory infections (46%), sepsis (29%), gastroenteritis (13%), musculoskeletal pain (9%), and malaria (5%). Antibiotic prescribing was high in all age-groups and settings. Trimethoprim-sulfamethoxazole (40%) and amoxicillin (29%) were the most commonly prescribed antibiotics and were used for nearly all clinical diagnoses. In these settings with minimal access to diagnostic tools, patients with fever and a negative mRDT received a limited number of clinical diagnoses. Many were likely to be inaccurate and were associated with the inappropriate use of the limited range of available antibiotics. Prescription and diagnostic practices for NMFIs in the facilities require research and policy input. Resource-limited malaria-endemic countries urgently need more point-of-care diagnostic tools and evidence-based diagnosis and treatment algorithms to provide effective and cost-efficient care. SN - 1476-1645 UR - https://www.unboundmedicine.com/medline/citation/32588795/Prevalence_and_Clinical_Management_of_Non-malarial_Febrile_Illnesses_among_Outpatients_in_the_Era_of_Universal_Malaria_Testing_in_Malawi L2 - http://www.ajtmh.org/content/journals/10.4269/ajtmh.18-0800?crawler=true&amp;mimetype=application/pdf DB - PRIME DP - Unbound Medicine ER -
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