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Trends in fever case management for febrile inpatients in a low malaria incidence setting of Tanzania.

Publication ,  Journal Article
Madut, DB; Rubach, MP; Bonnewell, JP; Cutting, ER; Carugati, M; Kalengo, N; Maze, MJ; Morrissey, AB; Mmbaga, BT; Lwezaula, BF; Kinabo, G ...
Published in: Trop Med Int Health
December 2021

OBJECTIVES: In 2010, WHO published guidelines emphasising parasitological confirmation of malaria before treatment. We present data on changes in fever case management in a low malaria transmission setting of northern Tanzania after 2010. METHODS: We compared diagnoses, treatments and outcomes from two hospital-based prospective cohort studies, Cohort 1 (2011-2014) and Cohort 2 (2016-2019), that enrolled febrile children and adults. All participants underwent quality-assured malaria blood smear-microscopy. Participants who were malaria smear-microscopy negative but received a diagnosis of malaria or received an antimalarial were categorised as malaria over-diagnosis and over-treatment, respectively. RESULTS: We analysed data from 2098 participants. The median (IQR) age was 27 (3-43) years and 1047 (50.0%) were female. Malaria was detected in 23 (2.3%) participants in Cohort 1 and 42 (3.8%) in Cohort 2 (p = 0.059). Malaria over-diagnosis occurred in 334 (35.0%) participants in Cohort 1 and 190 (17.7%) in Cohort 2 (p < 0.001). Malaria over-treatment occurred in 528 (55.1%) participants in Cohort 1 and 196 (18.3%) in Cohort 2 (p < 0.001). There were 30 (3.1%) deaths in Cohort 1 and 60 (5.4%) in Cohort 2 (p = 0.007). All deaths occurred among smear-negative participants. CONCLUSION: We observed a substantial decline in malaria over-diagnosis and over-treatment among febrile inpatients in northern Tanzania between two time periods after 2010. Despite changes, some smear-negative participants were still diagnosed and treated for malaria. Our results highlight the need for continued monitoring of fever case management across different malaria epidemiological settings in sub-Saharan Africa.

Duke Scholars

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Published In

Trop Med Int Health

DOI

EISSN

1365-3156

Publication Date

December 2021

Volume

26

Issue

12

Start / End Page

1668 / 1676

Location

England

Related Subject Headings

  • Young Adult
  • Tropical Medicine
  • Tanzania
  • Risk Factors
  • Prospective Studies
  • Overtreatment
  • Overdiagnosis
  • Male
  • Malaria
  • Inpatients
 

Citation

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Madut, D. B., Rubach, M. P., Bonnewell, J. P., Cutting, E. R., Carugati, M., Kalengo, N., … Crump, J. A. (2021). Trends in fever case management for febrile inpatients in a low malaria incidence setting of Tanzania. Trop Med Int Health, 26(12), 1668–1676. https://doi.org/10.1111/tmi.13683
Madut, Deng B., Matthew P. Rubach, John P. Bonnewell, Elena R. Cutting, Manuela Carugati, Nathaniel Kalengo, Michael J. Maze, et al. “Trends in fever case management for febrile inpatients in a low malaria incidence setting of Tanzania.Trop Med Int Health 26, no. 12 (December 2021): 1668–76. https://doi.org/10.1111/tmi.13683.
Madut DB, Rubach MP, Bonnewell JP, Cutting ER, Carugati M, Kalengo N, et al. Trends in fever case management for febrile inpatients in a low malaria incidence setting of Tanzania. Trop Med Int Health. 2021 Dec;26(12):1668–76.
Madut, Deng B., et al. “Trends in fever case management for febrile inpatients in a low malaria incidence setting of Tanzania.Trop Med Int Health, vol. 26, no. 12, Dec. 2021, pp. 1668–76. Pubmed, doi:10.1111/tmi.13683.
Madut DB, Rubach MP, Bonnewell JP, Cutting ER, Carugati M, Kalengo N, Maze MJ, Morrissey AB, Mmbaga BT, Lwezaula BF, Kinabo G, Mbwasi R, Kilonzo KG, Maro VP, Crump JA. Trends in fever case management for febrile inpatients in a low malaria incidence setting of Tanzania. Trop Med Int Health. 2021 Dec;26(12):1668–1676.
Journal cover image

Published In

Trop Med Int Health

DOI

EISSN

1365-3156

Publication Date

December 2021

Volume

26

Issue

12

Start / End Page

1668 / 1676

Location

England

Related Subject Headings

  • Young Adult
  • Tropical Medicine
  • Tanzania
  • Risk Factors
  • Prospective Studies
  • Overtreatment
  • Overdiagnosis
  • Male
  • Malaria
  • Inpatients