Malaria diagnosis and management in endemic countries: a still unsolved problem.
The last issue of BMJ focuses on the critical issue of the clinical
management of malaria in endemic countries (1,2). With a group of
researchers from Europe and Burkina Faso we just concluded a randomised
trial on malaria diagnosis and management both in the dry and the rainy
season (NCT00317590). Febrile patients were randomised either to be
managed clinically, or after a rapid diagnostic test (RDT) for malaria
(Paracheck®). Data are currently analysed, and will be published after a
full report has been submitted to the Ministry of Health of Burkina Faso.
Preliminary results for the dry season show no difference in malaria
management between the two groups: clinical officers don’t appear to take
into account test results. On the other hand there is a significant
decrease in “double diagnosis” (i.e., malaria plus a second diagnosis) in
patients submitted to the test. Since test-negative patients are anyhow
suspect for another diagnosis, even if they are treated as malaria, the
explanation for this overall drop in double diagnosis can only be that a
patient with a positive RDT is taken as a confirmed malaria case, without
considering another possibly life threatening condition. In a highly
endemic zone a positive RTD does not automatically mean that malaria is
the true cause of fever: these tests are very sensitive and may detect low
to very low parasitaemias without any clinical significance. Consequently,
there could be a risk of under treatment of other causes of fever, with a
potential harm to the patient.
In conclusion, as Reyburn and Coll. correctly affirm, the problem of
malaria diagnosis and management is complex and unlikely to be solved by
any magic bullet. We believe that this is a research issue of high
priority.
1.Hugh Reyburn, Hilda Mbakilwa, Rose Mwangi, Ombeni Mwerinde, Raimos
Olomi, Chris Drakeley, Christopher J M Whitty. Rapid diagnostic tests
compared with malaria microscopy for guiding outpatient treatment of
febrile illness in Tanzania: randomised trial. BMJ 2007;334:375-376
2.Talisuna A O and Meya D N. Diagnosis and treatment of malaria. BMJ
2007;334:403
Rapid Response:
Malaria diagnosis and management in endemic countries: a still unsolved problem.
The last issue of BMJ focuses on the critical issue of the clinical
management of malaria in endemic countries (1,2). With a group of
researchers from Europe and Burkina Faso we just concluded a randomised
trial on malaria diagnosis and management both in the dry and the rainy
season (NCT00317590). Febrile patients were randomised either to be
managed clinically, or after a rapid diagnostic test (RDT) for malaria
(Paracheck®). Data are currently analysed, and will be published after a
full report has been submitted to the Ministry of Health of Burkina Faso.
Preliminary results for the dry season show no difference in malaria
management between the two groups: clinical officers don’t appear to take
into account test results. On the other hand there is a significant
decrease in “double diagnosis” (i.e., malaria plus a second diagnosis) in
patients submitted to the test. Since test-negative patients are anyhow
suspect for another diagnosis, even if they are treated as malaria, the
explanation for this overall drop in double diagnosis can only be that a
patient with a positive RDT is taken as a confirmed malaria case, without
considering another possibly life threatening condition. In a highly
endemic zone a positive RTD does not automatically mean that malaria is
the true cause of fever: these tests are very sensitive and may detect low
to very low parasitaemias without any clinical significance. Consequently,
there could be a risk of under treatment of other causes of fever, with a
potential harm to the patient.
In conclusion, as Reyburn and Coll. correctly affirm, the problem of
malaria diagnosis and management is complex and unlikely to be solved by
any magic bullet. We believe that this is a research issue of high
priority.
1.Hugh Reyburn, Hilda Mbakilwa, Rose Mwangi, Ombeni Mwerinde, Raimos
Olomi, Chris Drakeley, Christopher J M Whitty. Rapid diagnostic tests
compared with malaria microscopy for guiding outpatient treatment of
febrile illness in Tanzania: randomised trial. BMJ 2007;334:375-376
2.Talisuna A O and Meya D N. Diagnosis and treatment of malaria. BMJ
2007;334:403
Competing interests:
None declared
Competing interests: No competing interests