title: Can treatment of malaria be restricted to parasitologically confirmed malaria? A school-based study in Benin in children with and without fever.
abstract: BACKGROUND
  Applying the switch from presumptive treatment of malaria to new policies of anti-malarial prescriptions restricted to parasitologically-confirmed cases is a still unsolved challenge. Pragmatic studies can provide data on consequences of such a switch. In order to assess whether restricting anti-malarials to rapid diagnostic test (RDT)-confirmed cases in children of between five and 15 years of age is consistent with an adequate management of fevers, a school-based study was performed in Allada, Benin.
  
  
  METHODS
  Children in the index group (with fever and a negative RDT) and the matched control group (without fever and a negative RDT) were not prescribed anti-malarials and actively followed-up during 14 days. Blood smears were collected at each assessment. Self-medication with chloroquine and quinine was assessed with blood spots. Malaria attacks during the follow-up were defined by persistent or recurrent fever concomitant to a positive malaria test.
  
  
  RESULTS
  484 children were followed-up (242 in each group). At day 3, fever had disappeared in 94% of children from the index group. The incidence of malaria was similar (five cases in the index group and seven cases in the control group) between groups. Self-medication with chloroquine and quinine in this cohort was uncommon.
  
  
  CONCLUSIONS
  Applying a policy of restricting anti-malarials to RDT-confirmed cases is consistent with an adequate management of fevers in this population. Further studies on the management of fever in younger children are of upmost importance.
authors.affiliation: Institut de Recherche pour le Développement (IRD); UMR 216: Mother and Child face to tropical infections, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Faucher
authors.forename: Patrick
authors.initials: P
authors.lastname: Makoutode
authors.forename: Grace
authors.initials: G
authors.lastname: Abiou
authors.forename: Todoégnon
authors.initials: T
authors.lastname: Béhéton
authors.forename: Pascal
authors.initials: P
authors.lastname: Houzé
authors.forename: Edgard
authors.initials: E
authors.lastname: Ouendo
authors.forename: Sandrine
authors.initials: S
authors.lastname: Houzé
authors.forename: Philippe
authors.initials: P
authors.lastname: Deloron
authors.forename: Michel
authors.initials: M
authors.lastname: Cot
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D001541:Benin; D001831:Body Temperature; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000469:parasitology; D008297:Male; D008853:Microscopy; D018512:Parasitemia / Q000175:diagnosis* / Q000188:drug therapy; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D011446:Prospective Studies
chemical_list: D000962:Antimalarials
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