Olaleye B O, Williams L A, D'Alessandro U, Weber M M, Mulholland K, Okorie C, Langerock P, Bennett S, Greenwood B M
MRC Laboratories, Fajara, Banjul, The Gambia.
Trans R Soc Trop Med Hyg. 1998 May-Jun;92(3):300-4. doi: 10.1016/s0035-9203(98)91021-5.
Diagnosis of malaria in children is difficult without laboratory support because the symptoms and signs of malaria overlap with those of other febrile illnesses such as pneumonia. Nevertheless, in many parts of Africa diagnosis of malaria must be made without laboratory investigation. Therefore, a scoring system has been developed to assist peripheral health care workers in making this diagnosis. Four hundred and seven Gambian children aged 6 months to 9 years who presented to a rural clinic with fever or a recent history of fever were investigated. A diagnosis of malaria was made in 159 children who had a fever of 38 degrees C or more and malaria parasitaemia of 5000 parasites/microL or more. Symptoms and signs in children with malaria were compared with those in children with other febrile illnesses to identify features which predicted malaria. Symptoms and signs were incorporated into various logistic regression models to test which were best independent predictors of malaria and these regression models were used to construct simple scoring systems which predicted malaria. A nine terms model predicted clinical malaria with a sensitivity of 89% and a specificity of 61%, values comparable to those obtained by an experienced paediatrician without laboratory support. The ability of peripheral health care workers to diagnose malaria using this approach is now being investigated in a prospective study.
在没有实验室支持的情况下，儿童疟疾的诊断很困难，因为疟疾的症状和体征与其他发热性疾病（如肺炎）的症状和体征重叠。然而，在非洲的许多地区，必须在没有实验室检查的情况下做出疟疾诊断。因此，已经开发了一种评分系统，以协助基层医疗保健工作者进行这种诊断。对407名6个月至9岁、因发热或近期有发热史而到一家农村诊所就诊的冈比亚儿童进行了调查。159名体温达到或超过38摄氏度且疟原虫血症为每微升5000个寄生虫或更多的儿童被诊断为疟疾。将疟疾患儿的症状和体征与其他发热性疾病患儿的症状和体征进行比较，以确定可预测疟疾的特征。将症状和体征纳入各种逻辑回归模型，以测试哪些是疟疾的最佳独立预测因素，并使用这些回归模型构建预测疟疾的简单评分系统。一个包含九个项目的模型预测临床疟疾的敏感性为89%，特异性为61%，这些值与在没有实验室支持的情况下由经验丰富的儿科医生得出的值相当。目前正在一项前瞻性研究中调查基层医疗保健工作者使用这种方法诊断疟疾的能力。
