Trends in fever case management for febrile inpatients in a low malaria incidence setting of Tanzania. Issue 12 (10th October 2021)

• Record Type: Journal Article
• Authors: Madut, Deng B.; Rubach, Matthew P.; Bonnewell, John P.; Cutting, Elena R.; Carugati, Manuela; Kalengo, Nathaniel; Maze, Michael J.; Morrissey, Anne B.; Mmbaga, Blandina T.; Lwezaula, Bingileki F.; Kinabo, Grace; Mbwasi, Ronald; Kilonzo, Kajiru G.; Maro, Venance P.; Crump, John A.
• Is Part Of: Tropical medicine & international health. Volume 26:Issue 12(2021)
• Page Start: 1668
• Page End: 1676
• Publication Date: 2021-10-10
• Subjects: Africa -- antimalarials -- fever -- malaria -- Tanzania; Tropical medicine -- Periodicals; Public health -- Periodicals; 616.988
• DOI: 10.1111/tmi.13683
• Languages: English
• ISSNs: 1360-2276

Abstract

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.