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. 1994;72(3):383–390.

Symptomatic identification of malaria in the home and in the primary health care clinic.

M Gomes 1, F E Espino 1, J Abaquin 1, C Realon 1, N P Salazar 1
PMCID: PMC2486711  PMID: 8062395

Abstract

In endemic areas in the absence of microscopy, the WHO case definition of malaria is the presence or a history of fever without other obvious cause. Yet there is little empirical evidence on the accuracy, predictability and reliability of clinical signs and symptoms for diagnosing malaria within different endemic settings. Studying patients in endemic communities in the Philippines, we found that fever alone did not discriminate well for malaria. In contrast, a sequential occurrence of fever, chills and/or sweating, or a combination of all three symptoms was a good general predictor of the disease. However, the place of diagnosis and observation (home or clinic), age, and season affected the positive predictive values obtained. Specificities and positive predictive values were greatest (over 80%) for those at most risk--children under 9 years of age in highly endemic communities--and were most reliable when the diagnosis was made at home. Predictive values were also greatest during the season when childhood acute lower respiratory infections in the study area increase. The good predictability of clinical signs and symptoms for high-risk groups suggests that simple protocols can be developed for the management of malaria in endemic areas of the Philippines.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alonso P. L., Bowman A., Marsh K., Greenwood B. M. The accuracy of the clinical histories given by mothers of seriously ill African children. Ann Trop Paediatr. 1987 Sep;7(3):187–189. doi: 10.1080/02724936.1987.11748504. [DOI] [PubMed] [Google Scholar]
  2. Delfini L. F. The relationship between body temperature and malaria parasitaemia in rural forest areas of Western Nigeria. J Trop Med Hyg. 1973 May;76(5):111–114. [PubMed] [Google Scholar]
  3. Fasan P. O., Lambo A. O. Malaria parasitaemia and body temperature in a semi-immune population in southern Nigeria. Bull World Health Organ. 1969;41(2):309–311. [PMC free article] [PubMed] [Google Scholar]
  4. Gomes M., Salazar N. P. Chemotherapy: principles in practice--a case study of the Philippines. Soc Sci Med. 1990;30(7):789–796. doi: 10.1016/0277-9536(90)90202-4. [DOI] [PubMed] [Google Scholar]
  5. Govardhini P., Manoharan A., Subramanian S., Mohapatra S. S., Jambulingam P., Das P. K. Symptomatic diagnosis of Plasmodium falciparum malaria in field conditions. Indian J Malariol. 1991 Mar;28(1):55–62. [PubMed] [Google Scholar]
  6. Jackson L. C. Malaria in Liberian children and mothers: biocultural perceptions of illness vs clinical evidence of disease. Soc Sci Med. 1985;20(12):1281–1287. doi: 10.1016/0277-9536(85)90382-x. [DOI] [PubMed] [Google Scholar]
  7. Lengeler C., de Savigny D., Mshinda H., Mayombana C., Tayari S., Hatz C., Degrémont A., Tanner M. Community-based questionnaires and health statistics as tools for the cost-efficient identification of communities at risk of urinary schistosomiasis. Int J Epidemiol. 1991 Sep;20(3):796–807. doi: 10.1093/ije/20.3.796. [DOI] [PubMed] [Google Scholar]
  8. O'Holohan D. R. Clinical and laboratory presentation of malaria: an analysis of one thousand subjects with malaria parasitaemia. J Trop Med Hyg. 1976 Sep;79(9):191–196. [PubMed] [Google Scholar]
  9. Olivar M., Develoux M., Chegou Abari A., Loutan L. Presumptive diagnosis of malaria results in a significant risk of mistreatment of children in urban Sahel. Trans R Soc Trop Med Hyg. 1991 Nov-Dec;85(6):729–730. doi: 10.1016/0035-9203(91)90432-x. [DOI] [PubMed] [Google Scholar]
  10. Rooth I., Björkman A. Fever episodes in a holoendemic malaria area of Tanzania: parasitological and clinical findings and diagnostic aspects related to malaria. Trans R Soc Trop Med Hyg. 1992 Sep-Oct;86(5):479–482. doi: 10.1016/0035-9203(92)90076-o. [DOI] [PubMed] [Google Scholar]
  11. Rougemont A., Breslow N., Brenner E., Moret A. L., Dumbo O., Dolo A., Soula G., Perrin L. Epidemiological basis for clinical diagnosis of childhood malaria in endemic zone in West Africa. Lancet. 1991 Nov 23;338(8778):1292–1295. doi: 10.1016/0140-6736(91)92592-p. [DOI] [PubMed] [Google Scholar]
  12. Sheps S. B., Schechter M. T. The assessment of diagnostic tests. A survey of current medical research. JAMA. 1984 Nov 2;252(17):2418–2422. [PubMed] [Google Scholar]
  13. Stein C. M., Gelfand M. The clinical features and laboratory findings in acute Plasmodium falciparum malaria in Harare, Zimbabwe. Cent Afr J Med. 1985 Sep;31(9):166–170. [PubMed] [Google Scholar]
  14. Trape J. F., Peelman P., Morault-Peelman B. Criteria for diagnosing clinical malaria among a semi-immune population exposed to intense and perennial transmission. Trans R Soc Trop Med Hyg. 1985;79(4):435–442. doi: 10.1016/0035-9203(85)90054-9. [DOI] [PubMed] [Google Scholar]
  15. Velema J. P., Alihonou E. M., Gandaho T., Hounye F. H. Childhood mortality among users and non-users of primary health care in a rural west African community. Int J Epidemiol. 1991 Jun;20(2):474–479. doi: 10.1093/ije/20.2.474. [DOI] [PubMed] [Google Scholar]

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