Rapid Diagnostic Test–Based Management of Malaria: An Effectiveness Study in Papua New Guinean Infants With Plasmodium falciparum and Plasmodium vivax Malaria
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BACKGROUND: In malaria-endemic areas it is recommended that febrile children be tested for malaria by rapid diagnostic test (RDT) or blood slide (BS) and receive effective malaria treatment only if results are positive. However, RDTs are known to perform less well for Plasmodium vivax. We evaluated the safety of withholding antimalarial drugs from young Papua New Guinean children with negative RDT results in areas with high levels of both Plasmodium falciparum and P. vivax infections. METHODS: Longitudinal prospective study of children aged 3-27 months visiting outpatient clinics for fever. RDT was administered at first visit. RDT and microscopy were performed if children returned because of persistent symptoms. Outcomes were rates of reattendance and occurrence of severe illnesses. RESULTS: Of 5670 febrile episodes, 3942 (70%) involved a negative RDT result. In 133 cases (3.4%), the children reattended the clinic within 7 days for fever, of whom 29 (0.7%) were parasitemic by RDT or microscopy. Of children who reattended, 24 (0.7%) presented with a severe illness: 2 had lower respiratory tract infections (LRTIs) with low-density P. vivax on BS; 2 received a diagnosis of P. vivax malaria on the basis of RDT but BSs were negative; 16 had LRTIs; 3 had alternative diagnoses. Of these 24, 22 were cured at day 28. Two children died of illnesses other than malaria and were RDT and BS negative at the initial and subsequent visits. CONCLUSION: Treatment for malaria based on RDT results is safe and feasible even in infants living in areas with moderate to high endemicity for both P. falciparum and P. vivax infections.
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Combination RDTs detecting both P. falciparum-HRP-2 and genus-specific pLDH are most appropriate in PNG.
“Given all human malaria species, bar Plasmodium knowlesi, are sympatric in PNG, combination RDTs detecting both P. falciparum-histidine-rich-protein-2 (HRP-2) and the genus-specific malaria antigen lactate dehydrogenase (pLDH) are most appropriate, and were shown to be appropriate for malaria treatment amongst febrile children in PNG [25].”
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- Authors
- Senn, N., Rarau, P., Manong, D., Salib, M., Siba, P., Robinson, L. J., Reeder, J., Rogerson, S., Mueller, I., & Genton, B.
- Affiliations
- Swiss Tropical and Public Health Institute (CH)
- Papua New Guinea Institute of Medical Research (PG)
- Walter and Eliza Hall Institute of Medical Research (AU)
- Burnet Institute (AU)
- The University of Melbourne (AU)
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-12-23
- Volume
- 54
- Issue
- 5
- Pages
- 644-651
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2103213082
- Cited by
- 39
- References
- 26
- Citations by year
- 2025: 1 · 2024: 1 · 2022: 2 · 2021: 1 · 2020: 1 · 2019: 1 · 2018: 2 · 2017: 1 · 2016: 3 · 2015: 6 · 2014: 7 · 2013: 7 · 2012: 6
- FWCI
- 6.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- SERVAL (Université de Lausanne) (publishedVersion, other-oa)
- reroDoc Digital Library (submittedVersion)
- IRIS (submittedVersion)
- edoc (University of Basel) (submittedVersion)
- Funders
- Bill and Melinda Gates Foundation (34678)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Health Sciences › Medicine › Genetics › Hemoglobinopathies and Related Disorders
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Travel-related health issues
- Keywords
- malaria, rapid diagnostic tests, Plasmodium falciparum, Plasmodium vivax, infants, febrile illness, diagnostic accuracy, re-attendance, severe illness, lower respiratory tract infection, Papua New Guinea
- MeSH terms
- Antimalarials, Child, Preschool, Humans, Infant, Outpatients, Papua New Guinea, Malaria, Falciparum, Malaria, Vivax, Treatment Outcome
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