title: Rapid diagnostic test-based management of malaria: an effectiveness study in Papua New Guinean infants with Plasmodium falciparum and Plasmodium vivax malaria.
abstract: BACKGROUND
  In malaria-endemic areas it is recommended that febrile children be tested for malaria by rapid diagnostic test (RDT) or blood slide (BS) and receive effective malaria treatment only if results are positive. However, RDTs are known to perform less well for Plasmodium vivax. We evaluated the safety of withholding antimalarial drugs from young Papua New Guinean children with negative RDT results in areas with high levels of both Plasmodium falciparum and P. vivax infections.
  
  
  METHODS
  Longitudinal prospective study of children aged 3-27 months visiting outpatient clinics for fever. RDT was administered at first visit. RDT and microscopy were performed if children returned because of persistent symptoms. Outcomes were rates of reattendance and occurrence of severe illnesses.
  
  
  RESULTS
  Of 5670 febrile episodes, 3942 (70%) involved a negative RDT result. In 133 cases (3.4%), the children reattended the clinic within 7 days for fever, of whom 29 (0.7%) were parasitemic by RDT or microscopy. Of children who reattended, 24 (0.7%) presented with a severe illness: 2 had lower respiratory tract infections (LRTIs) with low-density P. vivax on BS; 2 received a diagnosis of P. vivax malaria on the basis of RDT but BSs were negative; 16 had LRTIs; 3 had alternative diagnoses. Of these 24, 22 were cured at day 28. Two children died of illnesses other than malaria and were RDT and BS negative at the initial and subsequent visits.
  
  
  CONCLUSIONS
  Treatment for malaria based on RDT results is safe and feasible even in infants living in areas with moderate to high endemicity for both P. falciparum and P. vivax infections.
authors.affiliation: Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea. nicolas.senn@gmail.com
authors.forename: Nicolas
authors.initials: N
authors.lastname: Senn
authors.forename: Patricia
authors.initials: P
authors.lastname: Rarau
authors.forename: Doris
authors.initials: D
authors.lastname: Manong
authors.forename: Mary
authors.initials: M
authors.lastname: Salib
authors.forename: Peter
authors.initials: P
authors.lastname: Siba
authors.forename: Leanne J
authors.initials: LJ
authors.lastname: Robinson
authors.forename: John
authors.initials: J
authors.lastname: Reeder
authors.forename: Stephen
authors.initials: S
authors.lastname: Rogerson
authors.forename: Ivo
authors.initials: I
authors.lastname: Mueller
authors.forename: Blaise
authors.initials: B
authors.lastname: Genton
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D016780:Malaria, Vivax / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D010045:Outpatients; D010219:Papua New Guinea; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials