Reduction in the proportion of fevers associated with Plasmodium falciparum parasitaemia in Africa: a systematic review.

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Serval ID
serval:BIB_2D33BDEBAB7E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Reduction in the proportion of fevers associated with Plasmodium falciparum parasitaemia in Africa: a systematic review.
Journal
Malaria Journal
Author(s)
D'Acremont V., Lengeler C., Genton B.
ISSN
1475-2875 (Electronic)
ISSN-L
1475-2875
Publication state
Published
Issued date
2010
Volume
9
Pages
240
Language
english
Notes
Publication types: Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Review
Publication Status: epublish
Abstract
BACKGROUND: Malaria is almost invariably ranked as the leading cause of morbidity and mortality in Africa. There is growing evidence of a decline in malaria transmission, morbidity and mortality over the last decades, especially so in East Africa. However, there is still doubt whether this decline is reflected in a reduction of the proportion of malaria among fevers. The objective of this systematic review was to estimate the change in the Proportion of Fevers associated with Plasmodium falciparum parasitaemia (PFPf) over the past 20 years in sub-Saharan Africa.
METHODS: Search strategy. In December 2009, publications from the National Library of Medicine database were searched using the combination of 16 MeSH terms.Selection criteria. Inclusion criteria: studies 1) conducted in sub-Saharan Africa, 2) patients presenting with a syndrome of 'presumptive malaria', 3) numerators (number of parasitologically confirmed cases) and denominators (total number of presumptive malaria cases) available, 4) good quality microscopy.Data collection and analysis. The following variables were extracted: parasite presence/absence, total number of patients, age group, year, season, country and setting, clinical inclusion criteria. To assess the dynamic of PFPf over time, the median PFPf was compared between studies published in the years ≤2000 and > 2000.
RESULTS: 39 studies conducted between 1986 and 2007 in 16 different African countries were included in the final analysis. When comparing data up to year 2000 (24 studies) with those afterwards (15 studies), there was a clear reduction in the median PFPf from 44% (IQR 31-58%; range 7-81%) to 22% (IQR 13-33%; range 2-77%). This dramatic decline is likely to reflect a true change since stratified analyses including explanatory variables were performed and median PFPfs were always lower after 2000 compared to before.
CONCLUSIONS: There was a considerable reduction of the proportion of malaria among fevers over time in Africa. This decline provides evidence for the policy change from presumptive anti-malarial treatment of all children with fever to laboratory diagnosis and treatment upon result. This should insure appropriate care of non-malaria fevers and rationale use of anti-malarials.
Keywords
Adolescent, Adult, Africa South of the Sahara/epidemiology, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Fever/epidemiology, Fever/etiology, Humans, Incidence, Infant, Infant, Newborn, Malaria, Falciparum/epidemiology, Malaria, Falciparum/parasitology, Male, Middle Aged, Parasitemia/epidemiology, Parasitemia/etiology, Plasmodium falciparum/isolation & purification, Young Adult
Pubmed
Web of science
Open Access
Yes
Create date
27/10/2010 12:32
Last modification date
20/08/2019 13:12
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