ArticleMalaria journal2008
Overuse of artemisinin-combination therapy in Mto wa Mbu (river of mosquitoes), an area misinterpreted as high endemic for malaria.
Article in Malaria journal, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 2 of them syntheses that pooled it.
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Who cites it
34 citing papers in PubMed, 2 syntheses or guidelines pooled it, 56 citations in OpenAlex.
- Diagnosing acute and prevalent HIV-1 infection in young African adults seeking care for fever: a systematic review and audit of current practice.International health · 2014Pooled it
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- Prescriber and patient-oriented behavioural interventions to improve use of malaria rapid diagnostic tests in Tanzania: facility-based cluster randomised trial.BMC medicine · 2015Trial
- A cluster-randomized trial of mass drug administration with a gametocytocidal drug combination to interrupt malaria transmission in a low endemic area in Tanzania.Malaria journal · 2011Trial
- Predictive markers of transmission in areas with different malaria endemicity in north-eastern Tanzania based on seroprevalence of antibodies against Plasmodium falciparum.BMC research notes · 2021Article
- Assessing the Performance of CareStart™ Malaria Rapid Diagnostic Tests in Northwest Ethiopia: A Cross-Sectional Study.Journal of parasitology research · 2021Article
- Prevalence ofAfrican health sciences · 2020Article
- Prevalence ofThe East African health research journal · 2018Article
- Overdiagnosis across medical disciplines: a scoping review.BMJ open · 2017Article
- Demand-related factors influencing caregivers' awareness of malaria tests and health workers' testing practices, in Makarfi, Nigeria.Malaria journal · 2017Article
- Cost benefit analysis of malaria rapid diagnostic test: the perspective of Nigerian community pharmacists.Malaria journal · 2017Article
- Low prevalence of laboratory-confirmed malaria in clinically diagnosed adult women from the Wakiso district of Uganda.Malaria journal · 2016Article
- Optimal price subsidies for appropriate malaria testing and treatment behaviour.Malaria journal · 2016Article
- Malaria and HIV among pediatric inpatients in two Tanzanian referral hospitals: A prospective study.Acta tropica · 2016Article
- Challenges in the Etiology and Diagnosis of Acute Febrile Illness in Children in Low- and Middle-Income Countries.Journal of the Pediatric Infectious Diseases Society · 2016Review
- Article
- Prescription practices for malaria in Mozambique: poor adherence to the national protocols for malaria treatment in 22 public health facilities.Malaria journal · 2015Article
- Impact of rapid diagnostic tests for the diagnosis and treatment of malaria at a peripheral health facility in Western Uganda: an interrupted time series analysis.Malaria journal · 2015Article
- Assessment of competence of participants before and after 7-day intensive malaria microscopy training courses in Nigeria.MalariaWorld journal · 2015Article
- Occurrence of pfatpase6 Single Nucleotide Polymorphisms Associated with Artemisinin Resistance among Field Isolates of Plasmodium falciparum in North-Eastern Tanzania.Malaria research and treatment · 2015Article
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Authors and funding
10 authors at 6 institutions in 4 countries.
Funding
Abstract
backgroundAdequate malaria diagnosis and treatment remain major difficulties in rural sub-Saharan Africa. These issues deserve renewed attention in the light of first-line treatment with expensive artemisinin-combination therapy (ACT) and changing patterns of transmission intensity. This study describes diagnostic and treatment practices in Mto wa Mbu, an area that used to be hyperendemic for malaria, but where no recent assessments of transmission intensity have been conducted.
methodsRetrospective and prospective data were collected from the two major village health clinics. The diagnosis in prospectively collected data was confirmed by microscopy. The level of transmission intensity was determined by entomological assessment and by estimating sero-conversion rates using anti-malarial antibody responses.
resultsMalaria transmission intensity by serological assessment was equivalent to < 1 infectious bites per person per year. Despite low transmission intensity, > 40% of outpatients attending the clinics in 2006-2007 were diagnosed with malaria. Prospective data demonstrated a very high overdiagnosis of malaria. Microscopy was unreliable with < 1% of slides regarded as malaria parasite-positive by clinic microscopists being confirmed by trained research microscopists. In addition, many 'slide negatives' received anti-malarial treatment. As a result, 99.6% (248/249) of the individuals who were treated with ACT were in fact free of malaria parasites.
conclusionTransmission intensity has dropped considerably in the area of Mto wa Mbu. Despite this, most fevers are still regarded and treated as malaria, thereby ignoring true causes of febrile illness and over-prescribing ACT. The discrepancy between the perceived and actual level of transmission intensity may be present in many areas in sub-Saharan Africa and calls for greater efforts in defining levels of transmission on a local scale to help rational drug-prescribing behaviour.
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