title: Malaria presumptive treatment in Tanzania: is it rational approach for malaria management in rural health units?
abstract: Against imperfect performance of presumptive treatment strategy in malaria management in most endemic areas with perennial and seasonal transmission, its potential benefits have not been adequately evaluated in areas with low malaria transmission. We assessed the rationality of presumptive treatment in 688 Tanzanian children attended at the Amani government rural dispensary, northeast Tanzania, an area with low malaria transmission form April to December 1993. A total of 549 (80%)) children were clinically diagnosed by the attending clinical officer and managed as malaria cases. Among these, 216 (39%) children were misdiagnosed based on the diagnosis criteria 1(DC1) of reported or history of fever plus asexual Plasmodium falciparum density at any level. At cut-off point of reported or history of fever, axillary temperature of 37.5 degrees Centigrade or above plus asexual P. falciparum density of either >/=40 per microL (DC2) or >/=5000 per microL (DC3) of blood, 380 (67%) and 484 (88%) children were respectively erroneously diagnosed. The level of misdiagnosis increased with age and was significantly higher during the dry season. These findings suggests that in Amani an area with low malaria transmission, presumptive treatment based on reported or history fever was less effective resulting into a substantial proportion of children being inappropriately managed. However, in the absence of sensitive, simple and affordable diagnostic devices in rural health units, we consider that effective use of thermometers and consideration of alternative diagnosis among feverish children might minimise the magnitude of unwarranted malaria treatment.
authors.affiliation: National Institutr for Medical Research,Amani Medical Research Center,P.O Box 4, AMANI, Tanzania.
authors.forename: J J
authors.initials: JJ
authors.lastname: Massaga
authors.forename: M L
authors.initials: ML
authors.lastname: Kamugisha
authors.forename: F M
authors.initials: FM
authors.lastname: Salumi