TY - JOUR
T1 - Could combined rapid diagnostic testing for malaria and c-reactive protein be helpful for the diagnosis and management of febrile illnesses in children under-5 years of age in rural Burkina Faso?
AU - Bonko, Massa dit Achille
AU - Karama, Ibrahima
AU - Kiemde, Francois
AU - Lompo, Palpouguini
AU - Garba, Zakaria
AU - Yougbaré, Sibidou
AU - Mens, Petra F.
AU - Tinto, Halidou
AU - Tahita, Marc Christian
AU - Schallig, Henk. D. F. H.
N1 - Funding Information: The work was funded by a grant from The Netherlands Organization for Health Research and Development (ZonMw), Project 205300005; RAPDIF: a rapid diagnostic test for undifferentiated fever; and by a Discovery Award granted to the research team from the NESTA foundation (London, United Kingdom) to support research on antibiotic resistance. Funding Information: We would like to thank all study staff from “Institut de Recherche en Sciences de la Santé- Direction Régionale du Centre-Ouest/Unité de Recherche Clinique de Nanoro, Burkina Faso”, the participating rural health facilities (Nanoro, Godo, Nazoanga, and Seguedin), the hospital CMA Saint Camille de Nanoro and the Laboratory for Experimental Parasitology at the Amsterdam UMC their contributions to the work. We are indebted to the parents or guardians of the recruited children for providing informed consent and allowing their children to participate in our study. Funding Information: We prospectively included 396 children under 5 years of age with an axillary temperature of ≥ 37.5 °C in this study. Recruitment was carried out from April to December 2016 in the Nanoro Health District catchment area (Burkina Faso). Nanoro is a malaria-endemic area, located in the Central–West region of Burkina Faso at approximately 100 km from Ouagadougou, the capital city. This study was conducted in the framework of a large project (RAPDIF: a rapid diagnostic test for undifferentiated fevers; which is supported by a grant from the Netherlands Organisation for Health Research and Development (ZonMw), project 205300005), which aims to improve the diagnosis and management of febrile illness in children under 5 years of age []. Publisher Copyright: © 2022, The Author(s).
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Background: Febrile illnesses are among the most important reasons for medical consultation in sub-Saharan Africa and are frequently treated with antimicrobials due to the unavailability of appropriate diagnostic tools. This practice leads to antimicrobial resistance, with increasing mortality and morbidity as result. One of the few accessible diagnostic tools available in low resource settings is malaria rapid diagnostic tests (mRDTs) which contributed to reducing the over-prescription of anti-malarials, but cannot guide antibiotic prescriptions. To circumvent this problem, we explored whether combined testing with mRDT and c-reactive protein (CRP) could improve the diagnosis of febrile illnesses and subsequent prescription of antibiotics. Methods: Clinical specimens (blood, stool and urine) collected from 396 febrile children (axillary temperature of ≥ 37.5 °C) were analyzed with rapid diagnostic tests (malaria and CRP) and microbiology culture to establish the possible cause of fever. Actual antimicrobial prescriptions given to the children were compared with those that could be given based on combined CRP-malaria testing. Results: In total, 68.7% (272/396) of malaria cases were diagnosed by mRDT-Pf-HRP-2. CRP test was positive in 84.3% (334/396) of the children, but bacterial infections were confirmed in 12.4% (49/396) of them. A possible cause of fever could not be established in 20.5% (81/396) of cases. Based on the diagnostic practice in place, 265 of the children with a positive mRDT-Pf-HRP-2 received anti-malarial treatment. Furthermore, 89.5% (111/124) of negative mRDT results received antibiotic treatment and 37.1% (46/124) received antimalarial treatment. Of these 124 cases, 80 had positive CRP tests and 44 negative CRP tests. If the results of CRP testing are considered, 44 CRP/mRDT negative children would not get antibiotic treatment, resulting in a 35.5% reduction in antibiotic prescriptions. However, 2 cases with a bacterial infection would be denied appropriate treatment. Conclusion: Combining mRDT-PfHRP2 with CRP testing is particularly useful in children for whom both tests are negative as it results in a reduction of antibiotics prescriptions. However, there is a risk to miss potential severe bacterial infections and a close follow-up of these cases is strongly recommended.
AB - Background: Febrile illnesses are among the most important reasons for medical consultation in sub-Saharan Africa and are frequently treated with antimicrobials due to the unavailability of appropriate diagnostic tools. This practice leads to antimicrobial resistance, with increasing mortality and morbidity as result. One of the few accessible diagnostic tools available in low resource settings is malaria rapid diagnostic tests (mRDTs) which contributed to reducing the over-prescription of anti-malarials, but cannot guide antibiotic prescriptions. To circumvent this problem, we explored whether combined testing with mRDT and c-reactive protein (CRP) could improve the diagnosis of febrile illnesses and subsequent prescription of antibiotics. Methods: Clinical specimens (blood, stool and urine) collected from 396 febrile children (axillary temperature of ≥ 37.5 °C) were analyzed with rapid diagnostic tests (malaria and CRP) and microbiology culture to establish the possible cause of fever. Actual antimicrobial prescriptions given to the children were compared with those that could be given based on combined CRP-malaria testing. Results: In total, 68.7% (272/396) of malaria cases were diagnosed by mRDT-Pf-HRP-2. CRP test was positive in 84.3% (334/396) of the children, but bacterial infections were confirmed in 12.4% (49/396) of them. A possible cause of fever could not be established in 20.5% (81/396) of cases. Based on the diagnostic practice in place, 265 of the children with a positive mRDT-Pf-HRP-2 received anti-malarial treatment. Furthermore, 89.5% (111/124) of negative mRDT results received antibiotic treatment and 37.1% (46/124) received antimalarial treatment. Of these 124 cases, 80 had positive CRP tests and 44 negative CRP tests. If the results of CRP testing are considered, 44 CRP/mRDT negative children would not get antibiotic treatment, resulting in a 35.5% reduction in antibiotic prescriptions. However, 2 cases with a bacterial infection would be denied appropriate treatment. Conclusion: Combining mRDT-PfHRP2 with CRP testing is particularly useful in children for whom both tests are negative as it results in a reduction of antibiotics prescriptions. However, there is a risk to miss potential severe bacterial infections and a close follow-up of these cases is strongly recommended.
KW - Antibiotics
KW - Bacterial infections
KW - C-reactive protein
KW - Febrile children under 5
KW - Malaria
KW - mRDT-PfHRP-2
UR - http://www.scopus.com/inward/record.url?scp=85144326357&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s12879-022-07638-2
DO - https://doi.org/10.1186/s12879-022-07638-2
M3 - Article
C2 - 36536340
SN - 1471-2334
VL - 22
JO - BMC Infectious Diseases
JF - BMC Infectious Diseases
IS - 1
M1 - 952
ER -