Nov 28, 2014

The outcome of a test-treat package versus routine outpatient care for Ghanaian children with fever: a pragmatic randomized control trial

Malaria Journal
Emmanuel AmeyawImelda Bates

Abstract

Over-diagnosis of malaria among African children results in mismanagement of non-malaria infections. Limited laboratory capacity makes it difficult to implement policies that recommend pre-treatment confirmation of infections so a new approach with a package for on-the-spot management of fevers was evaluated. Febrile children presenting to outpatient clinic were randomized to receive either a 'test-treat' package (history with clinical examination; point-of-care tests; choice of artesunate-amodiaquine, co-amoxiclav and/or paracetamol) or routine outpatient care in a secondary health care facility in Kumasi, Ghana. A diagnosis of malaria, bacterial, viral or mixed malarial and bacterial infections was made using pre-defined criteria. Outcome was resolution of all symptoms including fever on day 7. The median age of the patients was 37.5 months (IQR: 19 to 66 months), with 56.7% being males. Compared to routine care the test-treat package resulted in less diagnoses of malaria, (37.2% vs 46.2%, p = 0.190) and mixed malaria and bacterial infections (14.0% vs 53.8%, p < 0.001) but more diagnoses of viral (33.1% vs 0.0%, p < 0.001) and bacterial infections only (15.7% vs 0.0%, p < 0.001). Less anti-malarials (51.2% vs 100.0%, p < 0.0...Continue Reading

  • References21
  • Citations1

Mentioned in this Paper

Acetaminophen
Laboratory Procedures
Antibiotic throat preparations
Point-of-Care Systems
Clinical Medicine
Antifungal Antibiotics, Topical
Antibiotics, Gynecological
Malaria
Malaria Vaccines
Amodiaquine

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