title: The contribution of microscopy to targeting antimalarial treatment in a low transmission area of Tanzania.
abstract: BACKGROUND
  There is a need for improved targeting of antimalarial treatment if artemisinin combination therapy is to be successfully introduced in Africa. This study aimed to explore why malaria slides are requested and how their results guide treatment decisions in an area of low transmission of P. falciparum.
  
  
  METHODS
  Outpatients attending a district hospital in a highland area of Tanzania were studied over a 3-week period. Clinical and social data were collected from patients who had been prescribed an antimalarial or sent for a malaria slide. Hospital slides were re-read later by research methods.
  
  
  RESULTS
  Of 1,273 consultations 132(10%) were treated presumptively for malaria and 214(17%) were sent for a malaria slide; only 13(6%) of these were reported positive for P. falciparum but 96(48%) of the 201 slide-negative cases were treated for malaria anyway. In a logistic regression model, adults (OR 3.86, P < 0.01), a history of fever (OR1.72, P = 0.03) and a longer travel time to the clinic (OR 1.77 per hour travelled, P < 0.01) independently predicted the request for a malaria slide. Only a history of a cough predicted (negatively) the prescription of an antimalarial with a negative slide result (OR 0.44, P < 0.01). The sensitivity and specificity of hospital slide results were 50% and 96% respectively.
  
  
  CONCLUSIONS
  Progress in targeting of antimalarials in low malaria transmission settings is likely to depend on consistent use of malaria microscopy and on the willingness of health workers to be guided by negative slide results. Further studies are needed to identify how this can be achieved.
authors.affiliation: Dept. of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, Keppel St, London WCIE 7HT, UK. hugh.reyburn@lshtm.ac.uk
authors.forename: Hugh
authors.initials: H
authors.lastname: Reyburn
authors.forename: John
authors.initials: J
authors.lastname: Ruanda
authors.forename: Ombeni
authors.initials: O
authors.lastname: Mwerinde
authors.forename: Chris
authors.initials: C
authors.lastname: Drakeley
mesh_terms: D000293:Adolescent; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D002675:Child, Preschool; D002985:Clinical Protocols / Q000592:standards; D003657:Decision Making; D005260:Female; D006801:Humans; D016015:Logistic Models; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000188:drug therapy* / Q000635:transmission; D008297:Male; D008853:Microscopy / Q000379:methods / Q000706:statistics & numerical data*; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D012680:Sensitivity and Specificity; D013636:Tanzania
chemical_list: D000962:Antimalarials