title: Presumptive treatment of fever cases as malaria: help or hindrance for malaria control?
abstract: BACKGROUND
  Malaria incidence has been reported to be falling in several countries in sub-Saharan Africa in recent years. This fall appears to have started before the widespread introduction of insecticide-treated nets. In the new era of calls to eliminate and eradicate malaria in sub-Saharan Africa, exploring possible causes for this fall seem pertinent.
  
  
  OBJECTIVE
  The authors explore an argument that presumptive treatment of fever cases as malaria may have played a role in reducing transmission of malaria by the prophylactic effect of antimalarials and their widespread use. This strategy, which is already in practise is termed Opportunistic Presumptive Treatment (OPT).
  
  
  METHODS
  Further comparison of epidemiological indicators between areas with OPT and more targeted treatment is required. If data suggest a benefit of OPT, combining long acting antimalarials that have an anti-gametocyticidal activity component plus using high levels of vector control measures may reduce transmission, prevent resistant strains spreading and be easily implemented.
  
  
  CONCLUSIONS
  OPT is practised widely by presumptive treatment of fever in health facilities and home management of fever. Improving diagnosis using rapid diagnostic tests and thus reducing the number of doses of antimalarials given may have counter intuitive effects on transmission in the context of elimination of malaria in high to moderate transmission settings.
authors.affiliation: Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Roly.gosling@gmail.com
authors.forename: Roly D
authors.initials: RD
authors.lastname: Gosling
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Drakeley
authors.forename: Alex
authors.initials: A
authors.lastname: Mwita
authors.forename: Daniel
authors.initials: D
authors.lastname: Chandramohan
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D000962:Antimalarials / Q000627:therapeutic use*; D005335:Fever of Unknown Origin / Q000188:drug therapy*; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D000962:Antimalarials