MALARIA: Africa's Children

Although several parasites can cause malaria it is the Plasmodium falciparum species that is responsible for the majority of the malaria deaths in Africa. In the countries at risk, artemisinin-combination therapy (ACT) has become the first-line treatment for the parasite.
However, there is concern that children suffering from a fever are mistakenly being given ACT when they do not actually have malaria.
This better-safe-than-sorry approach arose historically due to an absence of rapid diagnostics for the disease. While understandable, it leads to unnecessary waste of limited and valuable drug stocks, an increased risk of the parasite becoming resistant and the unfortunate consequence that children are being misdiagnosed and treated for the wrong condition.
Now that rapid diagnostic tests for malaria are available, there is a push to see them adopted and used widely. But there is a problem: while we know that ACT is being given to children without malaria, their proportion relative to malaria sufferers is not. This is because the data we have from clinics performing the treatments is either incomplete or unreliable, so it is difficult to accurately estimate how many non-sufferers are wrongly given ACT.
Fortunately, researchers from the Malaria Atlas Project have succeeded in modelling this proportion. Combining their expertise in mapping the infection risk for P. falciparum, together with data on the prevalence of childhood fever, treatment-seeking behaviour and child populations, they estimate that, in 2007, the majority of fevers in African children attending public clinics were not caused by malaria.
Their study, published in PLoS Medicine this week, also indicates that there are striking geographic differences. Children in some areas are much less likely to be suffering a fever due to malaria than in others. In Kenya, for example, approximately 15 per cent of fever sufferers seeking treatment are predicted to have malaria, whereas in Burkina Faso, it is nearer 60 per cent.
This model has implications for the healthcare agencies looking for the most rational and cost-effective way to use rapid diagnostic tests for malaria, and distribute drugs to the areas that need it the most. However, while the model is a step forward, the authors themselves sound a cautionary note:
What these models can never replace is high quality information from public sector services in the form of reliable and complete health information on drug use and patient burdens and whether these patients have peripheral infections.
Unfortunately, inadequacies in national health management information systems across Africa are in part a cause of the present imperfections in essential commodity demand and burden estimation.
http://wellcometrust.wordpress.com/2010/07/09/fever-and-malaria-in-african%c2%a0children/