Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Mar 1;16(1):95.
doi: 10.1186/s12936-017-1750-y.

Assessment of the utility of a symptom-based algorithm for identifying febrile patients for malaria diagnostic testing in Senegal

Julie Thwing  1 , Fatou Ba  2 , Alou Diaby  3 , Younouss Diedhiou  4 , Assane Sylla  3 , Guelaye Sall  3 , Mame Birame Diouf  5 , Alioune Badara Gueye  2 , Seynabou Gaye  2 , Medoune Ndiop  2 , Moustapha Cisse  2 , Daouda Ndiaye  6 , Mady Ba  2   7
Affiliations

Assessment of the utility of a symptom-based algorithm for identifying febrile patients for malaria diagnostic testing in Senegal

Julie Thwing et al. Malar J. .

Abstract

Background: Malaria rapid diagnostic tests (RDTs) enable point-of-care testing to be nearly as sensitive and specific as reference microscopy. The Senegal National Malaria Control Programme introduced RDTs in 2007, along with a case management algorithm for uncomplicated febrile illness, in which the first step stipulates that if a febrile patient of any age has symptoms indicative of febrile illness other than malaria (e.g., cough or rash), they would not be tested for malaria, but treated for the apparent illness and receive an RDT for malaria only if they returned in 48 h without improvement.

Methods: A year-long study in 16 health posts was conducted to determine the algorithm's capacity to identify patients with Plasmodium falciparum infection identifiable by RDT. Health post personnel enrolled patients of all ages with fever (≥37.5 °C) or history of fever in the previous 2 days. After clinical assessment, a nurse staffing the health post determined whether a patient should receive an RDT according to the diagnostic algorithm, but performed an RDT for all enrolled patients.

Results: Over 1 year, 6039 patients were enrolled and 58% (3483) were determined to require an RDT according to the algorithm. Overall, 23% (1373/6039) had a positive RDT, 34% (1130/3376) during rainy season and 9% (243/2661) during dry season. The first step of the algorithm identified only 78% of patients with a positive RDT, varying by transmission season (rainy 80%, dry 70%), malaria transmission zone (high 75%, low 95%), and age group (under 5 years 68%, 5 years and older 84%).

Conclusions: In all but the lowest malaria transmission zone, use of the algorithm excludes an unacceptably large proportion of patients with malaria from receiving an RDT at their first visit, denying them timely diagnosis and treatment. While the algorithm was adopted within a context of malaria control and scarce resources, with the goal of treating patients with symptomatic malaria, Senegal has now adopted a policy of universal diagnosis of patients with fever or history of fever. In addition, in the current context of malaria elimination, the paradigm of case management needs to shift towards the identification and treatment of all patients with malaria infection.

Keywords: Algorithm; Case management; Diagnosis; Fever; Malaria; Rapid diagnostic test; Treatment.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Senegal National Malaria Control Program case management algorithm for patients of all ages with uncomplicated febrile illness or history of fever in Senegal
Fig. 2
Fig. 2
Map of study sites by transmission zone. Filled circle study site. Source: Senegal National Malaria Control Program
See this image and copyright information in PMC

References

    1. Ministère de la Santé, de la Prévention et de l’Hygiène Publique/PNLP. Capitalisation de l’introduction des ACT au Sénégal. Rapport Etude IPDSR/UCAD. 2009.
    1. Ministère de la Santé et de la Prévention Médicale/PNLP. Etude de la faisabilité des TDR au Sénégal. Rapport Etude du Laboratoire de Parasitologie de l’UCAD. 2007.
    1. Ministère de la Santé, de la Prévention et de l’Hygiène Publique/PNLP. Capitalisation de l’introduction des TDR au Sénégal. Rapport Etude IPDSR/UCAD. 2009.
    1. Thiam S, Thior M, Faye B, Ndiop M, Diouf ML, Diouf MB, et al. Major reduction in anti-malarial drug consumption in Senegal after nation-wide introduction of malaria rapid diagnostic tests. PLoS ONE. 2011;6:e18419. doi: 10.1371/journal.pone.0018419. - DOI - PMC - PubMed
    1. Afrane YA, Zhou G, Githeko AK, Yan G. Clinical malaria case definition and malaria attributable fraction in the highlands of western Kenya. Malar J. 2014;13:405. doi: 10.1186/1475-2875-13-405. - DOI - PMC - PubMed

Publication types