Manguin Sylvie, Foumane Vincent, Besnard Patrick, Fortes Filomeno, Carnevale Pierre
Institut de Recherche pour le Développement France (IRD), Laboratoire d'Immuno-Physiopathologie Moléculaire Comparée, UMR-MD3, Montpellier, France.
Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale (OCEAC), Yaoundé, Cameroon.
Acta Trop. 2017 Jul;171:58-63. doi: 10.1016/j.actatropica.2017.03.022. Epub 2017 Mar 27.
Microscopic blood smear examinations done in health centers of Angola demonstrated a large overdiagnosis of malaria cases with an average rate of errors as high as 85%. Overall 83% of patients who received Coartem had an inappropriate treatment. Overestimated malaria diagnosis was noticed even when specific symptoms were part of the clinical observation, antimalarial treatments being subsequently given. Then, malaria overdiagnosis has three main consequences, (i) the lack of data reliability is of great concern, impeding epidemiological records and evaluation of the actual influence of operations as scheduled by the National Malaria Control Programme; (ii) the large misuse of antimalarial drug can increase the selective pressure for resistant strain and can make a false consideration of drug resistant P. falciparum crisis; and (iii) the need of strengthening national health centers in term of human, with training in microscopy, and equipment resources to improve malaria diagnosis with a large scale use of rapid diagnostic tests associated with thick blood smears, backed up by a "quality control" developed by the national health authorities. Monitoring of malaria cases was done in three Angolan health centers of Alto Liro (Lobito town) and neighbor villages of Cambambi and Asseque (Benguéla Province) to evaluate the real burden of malaria. Carriers of Plasmodium among patients of newly-borne to 14 years old, with or without fever, were analyzed and compared to presumptive malaria cases diagnosed in these health centers. Presumptive malaria cases were diagnosed six times more than the positive thick blood smears done on the same children. In Alto Liro health center, the percentage of diagnosis error reached 98%, while in Cambambi and Asseque it was of 79% and 78% respectively. The percentage of confirmed malaria cases was significantly higher during the dry (20.2%) than the rainy (13.2%) season. These observations in three peripheral health centers confirmed what has already been noticed in other malaria endemic regions, and highlight the need for an accurate evaluation of the Malaria control programme implemented in Angola.
在安哥拉各健康中心进行的显微血液涂片检查表明，疟疾病例存在大量过度诊断情况，平均误诊率高达85%。总体而言，接受科泰复治疗的患者中有83%接受了不恰当的治疗。即便特定症状是临床观察的一部分且随后给予了抗疟治疗，仍发现存在疟疾过度诊断的情况。疟疾过度诊断主要有三个后果：（i）数据可靠性不足令人高度担忧，这阻碍了流行病学记录以及对国家疟疾控制规划所安排行动实际影响的评估；（ii）抗疟药物的大量误用会增加耐药菌株的选择压力，并可能导致对恶性疟原虫耐药危机的错误判断；（iii）需要在人力方面加强国家健康中心，提供显微镜检查培训，并配备设备资源，以便通过大规模使用与厚血涂片相结合的快速诊断检测来改善疟疾诊断，同时要有国家卫生当局制定的“质量控制”作为支撑。在安哥拉上洛罗（洛比托镇）的三个健康中心以及坎班比和阿塞克（本格拉省）的邻近村庄对疟疾病例进行了监测，以评估疟疾的实际负担。对14岁及以下有或无发热症状的新生儿患者中的疟原虫携带者进行了分析，并与这些健康中心诊断的疑似疟疾病例进行了比较。疑似疟疾病例的诊断数量是对同一儿童进行的阳性厚血涂片检测结果的六倍。在上洛罗健康中心，诊断错误率达到98%，而在坎班比和阿塞克分别为79%和78%。确诊疟疾病例的百分比在旱季（20.2%）明显高于雨季（13.2%）。这三个周边健康中心的这些观察结果证实了其他疟疾流行地区已经注意到的情况，并凸显了准确评估安哥拉实施的疟疾控制规划的必要性。
