Parallel sessions - abstracts of presentations

2005 Acta Tropica  
Session title Abstract numbers Abstracts / Acta Tropica 95S (2005) S1-S506 S3 Conclusion: The Cameroon government has adopted sulfadoxine-pyrimethamine for the intermittent preventive treatment of malaria in pregnancy; administered in three doses in the second and third trimester of pregnancy. Malaria attack in the first trimester is managed as severe malaria with salts of quinine. Introduction: Urbanization has transformed malaria epidemiology in urban areas in sub-Saharan Africa (SSA). One
more » ... ortant feature is that endemicity levels tend to be lower than in surrounding rural areas. As a result, a higher proportion of fever episodes in children are not due to malaria but to other causes, and this has important implications for fever case management. We estimated the probabilities that individual febrile episodes were attributed to malaria in four urban centers in SSA. Methods: We estimated the malaria-attributable fraction of fever (MAFF) as part of a multi-site assessment of urban malaria in SSA. The fieldwork took place in Abidjan, Ouagadougou, Cotonou and Dar es Salaam. We categorized each site into three to four zones (centre, intermediate, periphery and rural areas), and randomly chose one clinic in each zone. In each clinic, we recruited 200 fever cases and 200 non-fever controls. Outpatients with a history of fever or a measured temperature >37.5 • C were defined as cases. Controls were recruited from patients in the same clinic without current or recent fever, matched by age and residency. Each patient had an interview, body temperature check, and thin and thick blood films taken. Results: The fever and control groups had a medium level of parasitaemia in Abidjan (34.7% versus 16.4%) and in Ouagadougou (22.0% versus 20.1%). The odds ratio of having parasitaemia in fever cases varied by different age groups: from 2.0 to 2.6 in Abidjan and from 0.8 to 2.1 in Ouagadougou. The estimated MAFF in infants, 1-5 years old, 5-15 years old and >15 years old were: 0.12, 0.22, 0.27, 0.13 in Abidjan, and −0.03, 0.13, 0.04, −0.02 in Ouagadougou. The overall preva-lence of malaria was surprising low in both fever and control groups in Dar es Salaam (5.2% versus 2.8%) and Cotonou (2.0% versus 1.8%). Odds ratios for parasitaemia ranged from 0.58 to 2.3 and 0.45 to 2.53. Both sites had extremely low MAFF too: −0.01 to 0.04. According to the routine malaria weekly reports we collected from each municipal health department for the last 3 years, 30-40% of all out-patient consultations in the four cities had a final diagnosis of malaria. Given the very low MAFF, misdiagnosis must be high and over-treatment frequent. Interpretation: Using a fever sign alone as a basis for malaria diagnosis leads to many unnecessary treatments, with consequences on cost, side-effects and the development of resistance. The clinical management of fevers in urban areas should be reviewed urgently. Abstracts / Acta Tropica 95S (2005) S1-S506 Abstracts / Acta Tropica 95S (2005) S1-S506
doi:10.1016/j.actatropica.2005.06.013 fatcat:gizw75udovexxlxrb6enkv4ade