Department of Infectiology and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.
Center of Pediatric and Adolescent Medicine, Johannes Gutenberg-University Medical Center, 55131 Mainz, Germany.
J Trop Pediatr. 2021 Jan 29;67(1). doi: 10.1093/tropej/fmaa135.
Acute mosquito-borne febrile diseases pose a threat to children in the Sub-Saharan-Africa with ∼272 000 children dying worldwide from malaria in 2018. Although the awareness for malaria in this area has increased due to improved health education, the apparent decline of actual malaria cases has not affected clinical practice significantly. This study collected clinical and epidemiologic data of children presenting with acute febrile diseases in order delineate their diagnostic and therapeutic management.
A hospital-based cross-sectional clinical study was conducted at the Sekou Toure Regional Referral Hospital in Tanzania. Children between 1 month and 12 years of age with an axillary temperature ≥ 37.5°C were recruited from August 2016 to December 2016. Children received full clinical examination. In addition, file data about diagnostics and treatment were collected and malaria rapid diagnostic tests (mRDTs) were performed. Confirmatory malaria polymerase chain reaction was performed from dry blood spots.
From 1381 children presented in the pediatric outpatient department, 133 met the inclusion criteria. Out of 133 febrile children, 10.5% were malaria positive. Treatment data indicate the prescription of antimalarials in 35.3% and antibiotics in 63.9% of the children with an overlap of 24.1% receiving both. Despite a negative mRDT, 36 patients received antimalarials.
The findings of this study confirm a significant decline of malaria cases in the Lake Victoria region. The discrepancy between the valuable results provided by mRDTs and the high prescription rates of antibiotics and antimalarials call for an enforced diagnostic and therapeutic algorithm.
The aim of the study was to take a closer look at reported cases of febrile diseases in the Lake Victoria region and assess the relationship between clinical as well as diagnostic findings and the resulting therapeutic concept. Based on these findings the prescription rate of antimalarial and antibiotic drugs was analyzed. The results showed an overall high prescription rate of antimalarials and antibiotics in both diagnosed malaria cases and cases with diagnosed bacterial infections.Not only with regards to the possible side effects of these medications but also keeping in mind the apparent misuse of resources this practice poses a serious burden to the health care system in this low resource country.
在撒哈拉以南非洲，急性蚊媒发热性疾病对儿童构成威胁，2018 年全世界有 272000 名儿童死于疟疾。尽管由于健康教育的改善，该地区对疟疾的认识有所提高，但实际疟疾病例的明显减少并未对临床实践产生重大影响。本研究收集了急性发热性疾病患儿的临床和流行病学数据，以明确其诊断和治疗管理方法。
在坦桑尼亚的 Sekou Toure 地区转诊医院进行了一项基于医院的横断面临床研究。2016 年 8 月至 12 月，招募了腋温≥37.5°C 的 1 个月至 12 岁的儿童。儿童接受了全面的临床检查。此外，还收集了有关诊断和治疗的数据，并进行了疟疾快速诊断检测（mRDT）。从干血斑中进行了确认疟疾聚合酶链反应。
在儿科门诊就诊的 1381 名儿童中，有 133 名符合纳入标准。在 133 名发热儿童中，10.5%为疟原虫阳性。治疗数据表明，35.3%的儿童使用了抗疟药，63.9%的儿童使用了抗生素，重叠使用的比例为 24.1%。尽管 mRDT 结果为阴性，但仍有 36 名患者使用了抗疟药。
本研究结果证实，维多利亚湖地区的疟疾病例显著减少。mRDT 提供的有价值的结果与抗生素和抗疟药的高处方率之间存在差异，这需要制定一个强制性的诊断和治疗方案。
本研究的目的是更详细地了解维多利亚湖地区报告的发热性疾病病例，并评估临床和诊断结果与治疗概念之间的关系。在此基础上，分析了抗疟药和抗生素药物的处方率。结果显示，在诊断为疟疾和诊断为细菌感染的病例中，抗疟药和抗生素的处方率均较高。考虑到这些药物可能产生的副作用，以及在资源匮乏的国家中这种滥用资源的明显情况，这对医疗保健系统构成了严重负担。
