Traore Karim, Thera Ali, Coulibaly Drissa, Koné Abdoulaye K, Guindo Boureima, Tangara Bourama, Diawara Aichatou A, Travassos Mark A, Thera Mahamadou A
Malaria Research and Training Center (MRTC), Faculty of Medicine and Odonto-Stomatology (FMOS), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.
Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland.
Am J Trop Med Hyg. 2024 Nov 12;112(1):72-78. doi: 10.4269/ajtmh.23-0564. Print 2025 Jan 8.
The investigation of factors associated with susceptibility to severe malaria is best achieved using case-control studies. The presence of a history of severe malaria in controls could affect the quality of their phenotype and study findings and hence should be rigorously determined. Here, we assessed the performance of a qualitative questionnaire to identify a history of cerebral malaria in controls in a case-control study of severe malaria in Mali. We evaluated the archived medical records of 220 children diagnosed with severe diseases at health care centers in rural and urban settings in Mali from 2018 to 2019. Parents of enrolled children were then identified and interviewed using a structured questionnaire by an investigator blinded to the diagnosis. The diagnosis derived from the interview was then compared with the diagnosis from the medical records as the reference diagnosis. The sensitivity and specificity of the questionnaire to detect cerebral malaria in history were, respectively, 84% and 76%. The questionnaire was concordant with the medical record diagnosis in 60% (95% CI: 50-71%) of cases. For other clinical phenotypes of malaria (severe malaria anemia, uncomplicated malaria, and severe malaria anemia concurrent with cerebral malaria), sensitivity and specificity ranged from 42% to 85% and 88% to 96%, respectively. Positive and negative predictive values were, respectively, 75% and 85%. The questionnaire demonstrated suitable sensitivity and specificity to identify cerebral malaria in a participant's history. In sub-Saharan Africa, a region with suboptimal medical record archives, such a tool could be used in case-control studies of severe malaria to select controls.
使用病例对照研究能最好地调查与严重疟疾易感性相关的因素。对照人群中严重疟疾病史的存在可能会影响其表型质量和研究结果，因此应严格确定。在此，我们在马里一项严重疟疾的病例对照研究中，评估了一份定性问卷在识别对照人群中脑型疟病史方面的表现。我们评估了2018年至2019年期间在马里农村和城市地区医疗保健中心被诊断患有严重疾病的220名儿童的存档病历。然后确定入选儿童的父母，并由一名对诊断不知情的调查员使用结构化问卷进行访谈。将访谈得出的诊断与病历诊断作为参考诊断进行比较。该问卷检测脑型疟病史的敏感性和特异性分别为84%和76%。在60%（95%可信区间：50 - 71%）的病例中，问卷与病历诊断一致。对于疟疾的其他临床表型（严重疟疾贫血、非复杂性疟疾以及并发脑型疟的严重疟疾贫血），敏感性和特异性分别为42%至85%和88%至96%。阳性预测值和阴性预测值分别为75%和85%。该问卷在识别参与者脑型疟病史方面表现出了合适的敏感性和特异性。在撒哈拉以南非洲这个病历存档情况欠佳的地区，这样一种工具可用于严重疟疾的病例对照研究以选择对照人群。
