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EDITORIALS: Zeno Bisoffi and Jef Van den Ende Costs of treating malaria according to test results BMJ 2008; 336: 168-169 [Full text]

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Compliance to malaria test results

Zeno Bisoffi, Jef Van den Ende   (28 January 2008)

What may explain pyrexia

Peter J Elton   (30 January 2008)

Compliance to malaria test results 28 January 2008
Zeno Bisoffi, Centre for Tropical Diseases S. Cuore Hospital, 37024 Negrar (Verona), Jef Van den Ende Send response to journal: Re: Compliance to malaria test results	We wish to aknowledge Dr. Gianni Tognoni's contribution to our Editorial (1). One of the great cardiovascular epidemiologists of our time, he pointed out that health workers' sub-optimal compliance to guidelines is well documented even in cardiovascular medicine and in other areas where the existing base of evidence is often more robust than in tropical medicine. He commented that "as it often happens in medicine, innovation coincides with the recognition that what is obvious should not be left aside, but taken very seriously because it is likely to play the key role in determining the outcomes". He added that "possibly however, the truly innovative contribution of the incorporation of a “behavioural” variable such as adherence into models aiming to govern policies, may be seen as a strong reminder of a more general rule: specifically in contexts like those where malaria is a priority, policy-informing models should be less normative, and more flexible, with a mandatory attention to include context and culture dependent variables". We believe that this message (one that is too often forgotten by technocrats) is of utmost importance for all who deal with International Health. References 1. Bisoffi Z, Van den Ende J. Costs of treating malaria according to test results. BMJ 2008;336(7637):168-9. Competing interests: None declared
What may explain pyrexia 30 January 2008
Peter J Elton, Director of Public Health Bury Primary Care Trust M7 4QY Send response to journal: Re: What may explain pyrexia	My colleague and I found, over thirty years ago, that, in Nigeria, it was inappropriate to assume that all febrile illness in children under the age of 5 was due to malaria (1). Although microscopy confirmed malaria in 37% of children with a rectal temprature of 100 degrees F or more, 21% had otitis media but no malaria with 7% having both otitis media and malaria. It may be that the epidemiology of these diseases have changed over time but in the absence of such evidence, our conclusion that "an examination of the ears of all children with a fever would be well rewarded" is probably still true. (1) Elton P, Cornell J, Study of otitis media & malaria among pyrexic attenders of an under-fives clinic. J Trop Med Hyg 1978;81;110-112 Competing interests: None declared