Department of Pharmacology & Therapeutics, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Trop Med Int Health. 2019 Nov;24(11):1291-1300. doi: 10.1111/tmi.13304. Epub 2019 Oct 3.
To investigate the consequence of restricting antimalarial treatment to febrile children that test positive to a malaria rapid diagnostic test (MRDT) only in an area of intense malaria transmission.
Febrile children aged 3-59 months were screened with an MRDT at health facilities in south-west Nigeria. MRDT-positive children received artesunate-amodiaquine (ASAQ), while MRDT-negative children were treated based on the clinical diagnosis of non-malaria febrile illness. The primary endpoint was the risk of developing microscopy-positive malaria within 28 days post-treatment.
309 (60.5%) of 511 children were MRDT-positive while 202 (39.5%) were MRDT-negative at enrolment. 18.5% (50/275) of MRDT-positive children and 7.6% (14/184) of MRDT-negative children developed microscopy-positive malaria by day 28 post-treatment (ρ = 0.001). The risk of developing clinical malaria by day 28 post-treatment was higher among the MRDT-positive group than the MRDT-negative group (adjusted OR 2.74; 95% CI, 1.4, 5.4). A higher proportion of children who were MRDT-positive at enrolment were anaemic on day 28 compared with the MRDT-negative group (12.6% vs. 3.1%; ρ = 0.001). Children in the MRDT-negative group made more unscheduled visits because of febrile illness than those in MRDT-positive group (23.2% vs. 12.0%; ρ = 0.001).
Restricting ACT treatment to MRDT-positive febrile children only did not result in significant adverse outcomes. However, the risk of re-infection within 28 days was significantly higher among MRDT-positive children despite ASAQ treatment. A longer-acting ACT may be needed as the first-line drug of choice for treating uncomplicated malaria in high-transmission settings to prevent frequent re-infections.
研究仅对疟疾快速诊断检测（MRDT）阳性的发热儿童进行抗疟治疗对疟疾高度传播地区的后果。
在尼日利亚西南部的卫生机构，对 3-59 个月大的发热儿童进行 MRDT 筛查。MRDT 阳性儿童接受青蒿琥酯-阿莫地喹（ASAQ）治疗，而 MRDT 阴性儿童则根据非疟疾发热性疾病的临床诊断进行治疗。主要终点是治疗后 28 天内发展为镜检阳性疟疾的风险。
309 名（60.5%）511 名儿童在入组时 MRDT 阳性，而 202 名（39.5%）MRDT 阴性。18.5%（50/275）的 MRDT 阳性儿童和 7.6%（14/184）的 MRDT 阴性儿童在治疗后 28 天内发展为镜检阳性疟疾（ρ=0.001）。治疗后 28 天内发生临床疟疾的风险在 MRDT 阳性组高于 MRDT 阴性组（调整后的 OR 2.74；95%CI，1.4，5.4）。与 MRDT 阴性组相比，MRDT 阳性组在第 28 天贫血的儿童比例更高（12.6% vs. 3.1%；ρ=0.001）。MRDT 阴性组因发热而未预约就诊的儿童比例高于 MRDT 阳性组（23.2% vs. 12.0%；ρ=0.001）。
仅对 MRDT 阳性发热儿童进行 ACT 治疗不会导致明显的不良后果。然而，尽管接受了 ASAQ 治疗，MRDT 阳性儿童在 28 天内再次感染的风险仍显著较高。在高传播地区，作为治疗无并发症疟疾的一线药物，可能需要使用作用时间更长的 ACT，以防止频繁再次感染。
