Peter Gething and colleagues compute the number of fevers likely to present to public health facilities in Africa and the estimated number of these fevers likely to be infected with Plasmodium falciparum malaria parasites

A Bhattarai

A Dicko

A Kiszewski

Abdisalan M. Noor

AM Noor

B Ngasala

C Drakeley

CA Guerra

CD Elvidge

Christopher J. M. Whitty

CIR Chandler

CR Polage

CS Molyneux

D Chandramohan

D Zurovac

DL Balk

DL Smith

DRS Ishengoma

EM Einterz

EM Malik

Emelda A. Okiro

F Font

F Nosten

HD Teklehaimanot

I Kleinschmidt

JM Kindermans

K Kallander

LM Barat

M Amexo

M English

ME Rafael

ML McMorrow

P Boisier

P Bouvier

P Olliaro

Peter W. Gething

PW Gething

RD Gosling

Robert W. Snow

RW Snow

S Shillcutt

SC McCombie

SI Hay

T Smith

TN Akenji

V D'Acremont

Victor A. Alegana

Viola C. Kirui

Y Lubell

English

PubMed

 malaria parasites. (range 60–103 million).Spatial estimates of childhood fevers and care-seeking rates can be combined with a relational risk model of infection prevalence in the community to estimate the degree of parasitemia in those fevers reaching public health facilities. This quantification provides an important baseline comparison of malarial and nonmalarial fevers in different endemicity settings that can contribute to ongoing scientific and policy debates about optimum clinical and financial strategies for the introduction of new diagnostics. These models are made publicly available with the publication of this paper.Please see later in the article for the Editors' Summar

Gething Peter W.

Kirui Viola C.

Alegana Victor A.

Okiro Emelda A.

Noor Abdisalan M.

Snow Robert W.

Public Library of Science (PLOS)

Estimating the Number of Paediatric Fevers Associated with Malaria Infection Presenting to Africa's Public Health Sector in 2007

BACKGROUND: As international efforts to increase the coverage of artemisinin-based combination therapy in public health sectors gather pace, concerns have been raised regarding their continued indiscriminate presumptive use for treating all childhood fevers. The availability of rapid-diagnostic tests to support practical and reliable parasitological diagnosis provides an opportunity to improve the rational treatment of febrile children across Africa. However, the cost effectiveness of diagnosis-based treatment polices will depend on the presumed numbers of fevers harbouring infection. Here we compute the number of fevers likely to present to public health facilities in Africa and the estimated number of these fevers likely to be infected with Plasmodium falciparum malaria parasites. METHODS AND FINDINGS: We assembled first administrative-unit level data on paediatric fever prevalence, treatment-seeking rates, and child populations. These data were combined in a geographical information system model that also incorporated an adjustment procedure for urban versus rural areas to produce spatially distributed estimates of fever burden amongst African children and the subset likely to present to public sector clinics. A second data assembly was used to estimate plausible ranges for the proportion of paediatric fevers seen at clinics positive for P. falciparum in different endemicity settings. We estimated that, of the 656 million fevers in African 0-4 y olds in 2007, 182 million (28%) were likely to have sought treatment in a public sector clinic of which 78 million (43%) were likely to have been infected with P. falciparum (range 60-103 million). CONCLUSIONS: Spatial estimates of childhood fevers and care-seeking rates can be combined with a relational risk model of infection prevalence in the community to estimate the degree of parasitemia in those fevers reaching public health facilities. This quantification provides an important baseline comparison of malarial and nonmalarial fevers in different endemicity settings that can contribute to ongoing scientific and policy debates about optimum clinical and financial strategies for the introduction of new diagnostics. These models are made publicly available with the publication of this paper

Gething, PW

Kirui, VC

Alegana, VA

Okiro, EA

Noor, AM

Snow, Robert

ORA - Oxford University Research Archive

Estimating the number of paediatric fevers associated with malaria infection presenting to Africa's public health sector in 2007.

Crossref

PLoS Medicine

Background: As international efforts to increase the coverage of artemisinin-based combination therapy in public health sectors gather pace, concerns have been raised regarding their continued indiscriminate presumptive use for treating all childhood fevers. The availability of rapid-diagnostic tests to support practical and reliable parasitological diagnosis provides an opportunity to improve the rational treatment of febrile children across Africa. However, the cost effectiveness of diagnosis-based treatment policies will depend on the presumed numbers of fevers harbouring infection. Here we compute the number of fevers likely to present to public health facilities in Africa and the estimated number of these fevers likely to be infected with Plasmodium falciparum malaria parasites. Methods and findings: We assembled first administrative-unit level data on paediatric fever prevalence, treatment-seeking rates, and child populations. These data were combined in a geographical information system model that also incorporated an adjustment procedure for urban versus rural areas to produce spatially distributed estimates of fever burden amongst African children and the subset likely to present to public sector clinics. A second data assembly was used to estimate plausible ranges for the proportion of paediatric fevers seen at clinics positive for P. falciparum in different endemicity settings. We estimated that, of the 656 million fevers in African 0-4 y olds in 2007, 182 million (28%) were likely to have sought treatment in a public sector clinic of which 78 million (43%) were likely to have been infected with P. falciparum (range 60-103 million). Conclusions: Spatial estimates of childhood fevers and care-seeking rates can be combined with a relational risk model of infection prevalence in the community to estimate the degree of parasitemia in those fevers reaching public health facilities. This quantification provides an important baseline comparison of malarial and nonmalarial fevers in different endemicity settings that can contribute to ongoing scientific and policy debates about optimum clinical and financial strategies for the introduction of new diagnostics. These models are made publicly available with the publication of this paper

Gething, Peter W.

Kirui, Viola C.

Alegana, Victor A.

Okiro, Emelda A.

Noor, Abdisalan M.

Snow, Robert W.

Oxford University Research Archive

Estimating the number of paediatric fevers associated with malaria infection presenting to Africa's public health sector in 2007

BackgroundAs international efforts to increase the coverage of artemisinin-based combination therapy in public health sectors gather pace, concerns have been raised regarding their continued indiscriminate presumptive use for treating all childhood fevers. The availability of rapid-diagnostic tests to support practical and reliable parasitological diagnosis provides an opportunity to improve the rational treatment of febrile children across Africa. However, the cost effectiveness of diagnosis-based treatment polices will depend on the presumed numbers of fevers harbouring infection. Here we compute the number of fevers likely to present to public health facilities in Africa and the estimated number of these fevers likely to be infected with Plasmodium falciparum malaria parasites.Methods and findingsWe assembled first administrative-unit level data on paediatric fever prevalence, treatment-seeking rates, and child populations. These data were combined in a geographical information system model that also incorporated an adjustment procedure for urban versus rural areas to produce spatially distributed estimates of fever burden amongst African children and the subset likely to present to public sector clinics. A second data assembly was used to estimate plausible ranges for the proportion of paediatric fevers seen at clinics positive for P. falciparum in different endemicity settings. We estimated that, of the 656 million fevers in African 0-4 y olds in 2007, 182 million (28%) were likely to have sought treatment in a public sector clinic of which 78 million (43%) were likely to have been infected with P. falciparum (range 60-103 million).ConclusionsSpatial estimates of childhood fevers and care-seeking rates can be combined with a relational risk model of infection prevalence in the community to estimate the degree of parasitemia in those fevers reaching public health facilities. This quantification provides an important baseline comparison of malarial and nonmalarial fevers in different endemicity settings that can contribute to ongoing scientific and policy debates about optimum clinical and financial strategies for the introduction of new diagnostics. These models are made publicly available with the publication of this paper

Peter W Gething

Viola C Kirui

Victor A Alegana

Emelda A Okiro

Abdisalan M Noor

Robert W Snow

Directory of Open Access Journals

A world malaria map: Plasmodium falciparum endemicity in

Abandoning presumptive antimalarial treatment for febrile children aged less than five years-a case of running before we can walk? PLoS Med 6:

Assembling a global database of malaria parasite prevalence for the Malaria Atlas Project.

Attributable fraction estimates and case definitions for malaria in endemic areas.

Available: http://www.fao.org/geonetwork/srv/cn/ metadata.show?id=12691.

Available: http://www.who.int/whosis/database/gis/ salb/salb_PO.htm.

Challenges in routine implementation and quality control of rapid diagnostic tests for malaria-Rufiji district,

Clinical and laboratory aspects of malaria among children with fever in a low transmission area of Sudan.

Costeffectiveness of malaria diagnostic methods in sub-Saharan Africa in an era of combination therapy.

Determining global population distribution: methods, applications and data.

Developing geostatistical space-time models to predict outpatient treatment burdens from incomplete national data.

Diagnostic accuracy and case management of clinical malaria in the primary health services of a rural area in south-eastern Tanzania.

Endemicity response timelines for Plasmodium falciparum elimination.

Estimated global resources needed to attain international malaria control goals.

Estimating antimalarial drugs consumption in Africa before the switch to artemisinin-based combination therapies (ACTs).

Factors influencing the effectiveness of malaria control in Bioko Island, equatorial Guinea.

Fever in Africa: do patients know when they are hot?

Four malaria success stories: how malaria burden was successfully reduced in

Guidelines and mindlines: why do clinical staff over-diagnose malaria in Tanzania? A qualitative study.

Health laboratories in the Tanga region of Tanzania: the quality of diagnostic services for malaria and other communicable diseases.

Health service providers in Somalia: their readiness to provide malaria case-management.

Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar.

Impact of training in clinical and microscopy diagnosis of childhood malaria on antimalarial drug prescription and health outcome at primary health care level in Tanzania: A randomized controlled trial.

Improving imperfect data from health management information systems in Africa using space-time geostatistics. PLoS Med 3: e271. doi:10.1371/ journal.pmed.0030271.

Insecticide-treated net coverage in Africa: mapping progress in 2000–07.

Is fever a good sign for clinical malaria in surveys of endemic communities.

Laboratory use in Ghana: physician perception and practice.

Malaria in Sa ˜o Tome ´ and Principe: on the brink of elimination after three years of effective antimalarial measures.

Malaria misdiagnosis: effects on the poor and vulnerable.

Malaria Monitoring and Evaluation Reference Group (RBM-MERG)

Management of fever and malaria - policy and practice.

Maternal responses to childhood fevers: a comparison of rural and urban residents in coastal Kenya.

Measuring malaria endemicity from intense to interrupted transmission.

Mills A

Modeling the financial and clinical implications of malaria rapid diagnostic tests in the case-management of older children and adults in Kenya.

Organization

Out with the old, in with the new: the utility of rapid diagnostic tests for malaria diagnosis in Africa. T Roy Soc Trop Med

Overview of DMSP OLS and scope of applications.

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

Radiance calibration of DMSP-OLS low-light imaging data of human settlements.

Reducing the burden of childhood malaria in Africa: the role of improved diagnostics.

Relationship between parasite density and fever risk in a community exposed to a low level of malaria transmission in Madagascar highlands.

Season, fever prevalence and pyrogenic threshold for malaria disease definition in an endemic area of Mali.

Seasonality and Malaria in a west African village: does high parasite density predict fever Incidence?

Symptom overlap for malaria and pneumonia-policy implications for home management strategies.

Teklehaimanot A

The detection and treatment of Plasmodium falciparum: time for change.

The epidemiology of malaria in Bolifamba, a rural community on the eastern slopes of Mount Cameroon: seasonal variation in the parasitological indices of transmission.

The impact of response to the results of diagnostic tests for malaria: cost-benefit analysis.

The limits and intensity of Plasmodium falciparum transmission: implications for malaria control and elimination worldwide.

Time to move from presumptive malaria treatment to laboratory-confirmed diagnosis and treatment in African children with fever.

Treatment seeking for malaria: a review of recent research.

Use of clinical algorithms for diagnosing malaria.

World Health Organization

World Health Organization (2009) World malaria report 2009. Geneva: World Health Organization.

World population prospects: the 2006 revision population database. http://esa.un.org/unpp/

file:///data/core-remote/dit/data/public_library_of_science/pdf/01f/ZnRwOi8vZnRwLm5jYmkubmxtLm5paC5nb3YvcHViL3BtYy9vYV9wYWNrYWdlL2Q3L2VmL1BNQzI4OTc3NjgudGFyLmd6.pdf

Estimating the Number of Paediatric Fevers Associated with Malaria Infection Presenting to Africa's Public Health Sector in 2007

Abstract

Similar works

Full text

Available Versions

Public Library of Science (PLOS)

ORA - Oxford University Research Archive

Crossref

Oxford University Research Archive

Oxford University Research Archive

Directory of Open Access Journals