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.
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.
Faucher
Jean-François
JF
Institut de Recherche pour le Développement, UMR 216 Mother and Child face with Tropical infections Research Unit, Paris, France.
Aubouy
Agnès
A
Béhéton
Todoégnon
T
Makoutode
Patrick
P
Abiou
Grace
G
Doritchamou
Justin
J
Houzé
Pascal
P
Ouendo
Edgard
E
Deloron
Philippe
P
Cot
Michel
M
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
D000962:Antimalarials