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. 2021 Dec;26(12):1668-1676.
doi: 10.1111/tmi.13683. Epub 2021 Oct 10.

Trends in fever case management for febrile inpatients in a low malaria incidence setting of Tanzania

Deng B Madut  1   2 , Matthew P Rubach  1   2 , John P Bonnewell  1   2   3 , Elena R Cutting  4 , Manuela Carugati  1 , Nathaniel Kalengo  5 , Michael J Maze  6   7 , Anne B Morrissey  1 , Blandina T Mmbaga  5   8 , Bingileki F Lwezaula  9 , Grace Kinabo  5 , Ronald Mbwasi  5 , Kajiru G Kilonzo  5   8 , Venance P Maro  5   8 , John A Crump  1   2   7
Affiliations

Trends in fever case management for febrile inpatients in a low malaria incidence setting of Tanzania

Deng B Madut et al. Trop Med Int Health. 2021 Dec.

Abstract

Objectives: In 2010, WHO published guidelines emphasising parasitological confirmation of malaria before treatment. We present data on changes in fever case management in a low malaria transmission setting of northern Tanzania after 2010.

Methods: We compared diagnoses, treatments and outcomes from two hospital-based prospective cohort studies, Cohort 1 (2011-2014) and Cohort 2 (2016-2019), that enrolled febrile children and adults. All participants underwent quality-assured malaria blood smear-microscopy. Participants who were malaria smear-microscopy negative but received a diagnosis of malaria or received an antimalarial were categorised as malaria over-diagnosis and over-treatment, respectively.

Results: We analysed data from 2098 participants. The median (IQR) age was 27 (3-43) years and 1047 (50.0%) were female. Malaria was detected in 23 (2.3%) participants in Cohort 1 and 42 (3.8%) in Cohort 2 (p = 0.059). Malaria over-diagnosis occurred in 334 (35.0%) participants in Cohort 1 and 190 (17.7%) in Cohort 2 (p < 0.001). Malaria over-treatment occurred in 528 (55.1%) participants in Cohort 1 and 196 (18.3%) in Cohort 2 (p < 0.001). There were 30 (3.1%) deaths in Cohort 1 and 60 (5.4%) in Cohort 2 (p = 0.007). All deaths occurred among smear-negative participants.

Conclusion: We observed a substantial decline in malaria over-diagnosis and over-treatment among febrile inpatients in northern Tanzania between two time periods after 2010. Despite changes, some smear-negative participants were still diagnosed and treated for malaria. Our results highlight the need for continued monitoring of fever case management across different malaria epidemiological settings in sub-Saharan Africa.

Keywords: Africa; Tanzania; antimalarials; fever; malaria.

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Figures

Figure 1.
Figure 1.
Screening and enrollment flow diagram for hospitalized patients enrolled in two febrile surveillance studies, Cohort 1 (2011–2014) and Cohort 2 (2016–2019), northern Tanzania
Figure 2.
Figure 2.
Adjusted prediction of malaria over-diagnosis and over-treatment among hospitalized patients in two febrile surveillance studies from September 2011 through May 2019. The central line displays the mean; gray areas represent 95% confidence interval.
See this image and copyright information in PMC

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