Prevalence and Clinical Management of Non-malarial Febrile Illnesses among Outpatients in the Era of Universal Malaria Testing in Malawi
| Autor: | Doreen Ali, Terrie E. Taylor, Clarissa Valim, Osward M. Nyirenda, Paul Pensulo, Atupele Kapito-Tembo, Andrew Bauleni, Miriam K. Laufer, Don P. Mathanga |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Malawi medicine.medical_specialty Adolescent Endemic Diseases Fever 030231 tropical medicine Young Adult 03 medical and health sciences 0302 clinical medicine Ambulatory care Musculoskeletal Pain Sepsis Virology Trimethoprim Sulfamethoxazole Drug Combination Health care Ambulatory Care Prevalence Humans Medicine Outpatient clinic Disease management (health) Medical prescription Medical diagnosis Young adult Child Respiratory Tract Infections business.industry Soft Tissue Infections Amoxicillin Disease Management Articles medicine.disease Anti-Bacterial Agents Gastroenteritis Malaria Infectious Diseases Child Preschool Emergency medicine Female Parasitology business |
| Zdroj: | Am J Trop Med Hyg |
| ISSN: | 1476-1645 0002-9637 |
| DOI: | 10.4269/ajtmh.18-0800 |
| Popis: | Increasing access to rapid diagnostic tests for malaria (mRDTs) has raised awareness of the challenges healthcare workers face in managing non-malarial febrile illnesses (NMFIs). We examined NMFI prevalence, clinical diagnoses, and prescribing practices in outpatient clinics across different malaria transmission settings in Malawi. Standardized facility-based malaria surveillance was conducted at three facilities one of every 4 weeks over 2 years. Information on demographics, presenting symptoms, temperature, clinical diagnosis, and treatment were collected from outpatients presenting with malaria-like symptoms. Of the 25,486 patients with fever, 69% had NMFI. Non-malarial febrile illness prevalence was lower in 5- to 15-year-old patients (55%) than in children < 5 years (72%) and adults > 15 years of age (77%). The most common clinical diagnoses among febrile patients with negative mRDTs in all age-groups and settings were respiratory infections (46%), sepsis (29%), gastroenteritis (13%), musculoskeletal pain (9%), and malaria (5%). Antibiotic prescribing was high in all age-groups and settings. Trimethoprim–sulfamethoxazole (40%) and amoxicillin (29%) were the most commonly prescribed antibiotics and were used for nearly all clinical diagnoses. In these settings with minimal access to diagnostic tools, patients with fever and a negative mRDT received a limited number of clinical diagnoses. Many were likely to be inaccurate and were associated with the inappropriate use of the limited range of available antibiotics. Prescription and diagnostic practices for NMFIs in the facilities require research and policy input. Resource-limited malaria-endemic countries urgently need more point-of-care diagnostic tools and evidence-based diagnosis and treatment algorithms to provide effective and cost-efficient care. |
| Databáze: | OpenAIRE |
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