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. 2008 Jul 16:7:132.
doi: 10.1186/1475-2875-7-132.

Presumptive treatment of fever cases as malaria: help or hindrance for malaria control?

Roly D Gosling  1 , Christopher J Drakeley, Alex Mwita, Daniel Chandramohan
Affiliations

Presumptive treatment of fever cases as malaria: help or hindrance for malaria control?

Roly D Gosling et al. Malar J. .

Abstract

Background: Malaria incidence has been reported to be falling in several countries in sub-Saharan Africa in recent years. This fall appears to have started before the widespread introduction of insecticide-treated nets. In the new era of calls to eliminate and eradicate malaria in sub-Saharan Africa, exploring possible causes for this fall seem pertinent.

Presentation of the hypothesis: The authors explore an argument that presumptive treatment of fever cases as malaria may have played a role in reducing transmission of malaria by the prophylactic effect of antimalarials and their widespread use. This strategy, which is already in practise is termed Opportunistic Presumptive Treatment (OPT).

Testing the hypothesis: Further comparison of epidemiological indicators between areas with OPT and more targeted treatment is required. If data suggest a benefit of OPT, combining long acting antimalarials that have an anti-gametocyticidal activity component plus using high levels of vector control measures may reduce transmission, prevent resistant strains spreading and be easily implemented.

Implications of the hypothesis: OPT is practised widely by presumptive treatment of fever in health facilities and home management of fever. Improving diagnosis using rapid diagnostic tests and thus reducing the number of doses of antimalarials given may have counter intuitive effects on transmission in the context of elimination of malaria in high to moderate transmission settings.

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References

    1. Guerra CA, Gikandi PW, Tatem AJ, Noor AM, Smith DL, Hay SI, Snow RW. The limits and intensity of Plasmodium falciparum transmission: implications for malaria control and elimination worldwide. PLoS Med. 2008;5:e38. doi: 10.1371/journal.pmed.0050038. - DOI - PMC - PubMed
    1. Okiro E, Hay SI, Gikandi PW, Sharif SK, Noor A, Peshu N, Marsh K, Snow RW. The decline in paediatric malaria admissions on the coast of Kenya. Malaria Journal. 2007;6 doi:10.1186/1475-2875-1186-1151. - PMC - PubMed
    1. Schellenberg D, Menendez C, Aponte J, Guinovart C, Mshinda H, Tanner M, Alonso P. The changing epideimology of malaria in Ifakara Town, Southern Tanzania. Tropical Medicine and International Health. 2004;9:68–76. doi: 10.1046/j.1365-3156.2003.01161.x. - DOI - PubMed
    1. Bhattarai A, Ali AS, Kachur P, Martensson A, Abbas AK, Khatib R, Al-mafazy A, Ramsan M, Rotllant G, Gerstenmaier JF, Molteni F, Abdulla S, Montgomery SM, Kaneko A, Bjorkman A. Impact of artemesinin- based combination therapy and insecticide- treated nets on malaria burden in Zanzibar. Plos Medicine. 2007;4:e309. doi: 10.1371/journal.pmed.0040309. - DOI - PMC - PubMed
    1. Sharp B, Kleinschmidt I, Streat E, Maharaj R, Barnes K, Durrheim DN, Ridl FC, Morris N, Seocharan I, Kunene S, La Grange JJP, Mthembu JD, Maartens F, Martin CL, Barreto A. Seven years of regional malaria control colaboration- Mozambique, South Africa and Swaziland. Am J Trop Med Hyg. 2007;76:42–47. - PMC - PubMed

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