title: Abandoning presumptive antimalarial treatment for febrile children aged less than five years--a case of running before we can walk?
abstract: Current guidelines recommend that all fever episodes in African children be treated presumptively with antimalarial drugs. But declining malarial transmission in parts of sub-Saharan Africa, declining proportions of fevers due to malaria, and the availability of rapid diagnostic tests mean it may be time for this policy to change. This debate examines whether enough evidence exists to support abandoning presumptive treatment and whether African health systems have the capacity to support a shift toward laboratory-confirmed rather than presumptive diagnosis and treatment of malaria in children under five.
authors.affiliation: KEMRI-Wellcome Trust Programme, Centre for Geographic Medicine Research-Coast, Nairobi, Kenya. menglish@nairobi.kemri-wellcome.org
authors.forename: Mike
authors.initials: M
authors.lastname: English
authors.forename: Hugh
authors.initials: H
authors.lastname: Reyburn
authors.forename: Catherine
authors.initials: C
authors.lastname: Goodman
authors.forename: Robert W
authors.initials: RW
authors.lastname: Snow
mesh_terms: D017954:Africa South of the Sahara; D000962:Antimalarials / Q000627:therapeutic use*; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000592:standards; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008288:Malaria / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000635:transmission
chemical_list: D000962:Antimalarials