title: What would PCR assessment change in the management of fevers in a malaria endemic area? A school-based study in Benin in children with and without fever.
abstract: BACKGROUND
  A recent school-based study in Benin showed that applying a policy of anti-malarial prescriptions restricted to parasitologically-confirmed cases on the management of fever is safe and feasible. Additional PCR data were analysed in order to touch patho-physiological issues, such as the usefulness of PCR in the management of malaria in an endemic area or the triggering of a malaria attack in children with submicroscopic malaria.
  
  
  METHODS
  PCR data were prospectively collected in the setting of an exposed (with fever)/non exposed (without fever) study design. All children had a negative malaria rapid diagnostic test (RDT) at baseline, were followed up to day 14 and did not receive drugs with anti-malarial activity. The index group was defined by children with fever at baseline and the control group by children without fever at baseline. Children with submicroscopic malaria in these two groups were defined by a positive PCR at baseline.
  
  
  RESULTS
  PCR was positive in 66 (27%) children of the index group and in 104 (44%) children of the control group respectively. The only significant factor positively related to PCR positivity at baseline was the clinical status (control group). When definition of malaria attacks included PCR results, no difference of malaria incidence was observed between the index and control groups, neither in the whole cohort, nor in children with submicroscopic malaria. The rate of undiagnosed malaria at baseline was estimated to 3.7% at baseline in the index group.
  
  
  CONCLUSIONS
  Treating all children with fever and a positive PCR would have led to a significant increase of anti-malarial consumption, with few benefits in terms of clinical events. Non malarial fevers do not or do not frequently trigger malaria attacks in children with submicroscopic malaria.
authors.affiliation: Institut de Recherche pour le Développement, UMR 216 Mother and Child face with Tropical infections Research Unit, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Faucher
authors.forename: Agnès
authors.initials: A
authors.lastname: Aubouy
authors.forename: Todoégnon
authors.initials: T
authors.lastname: Béhéton
authors.forename: Patrick
authors.initials: P
authors.lastname: Makoutode
authors.forename: Grace
authors.initials: G
authors.lastname: Abiou
authors.forename: Justin
authors.initials: J
authors.lastname: Doritchamou
authors.forename: Pascal
authors.initials: P
authors.lastname: Houzé
authors.forename: Edgard
authors.initials: E
authors.lastname: Ouendo
authors.forename: Philippe
authors.initials: P
authors.lastname: Deloron
authors.forename: Michel
authors.initials: M
authors.lastname: Cot
mesh_terms: D000962:Antimalarials / Q000191:economics / Q000627:therapeutic use; D001541:Benin / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000379:methods; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016778:Malaria, Falciparum / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology; D008297:Male; D008853:Microscopy; D018512:Parasitemia / Q000175:diagnosis* / Q000453:epidemiology; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction / Q000379:methods*; D011446:Prospective Studies
chemical_list: D000962:Antimalarials