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Syndromic Diagnosis of Malaria in Rural Sierra Leone and Proposed Additions to the National Integrated Management of Childhood Illness Guidelines for Fever

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  • 1 Tulane University Health Sciences Center, New Orleans, Louisiana; Medical Research Centre, Bo, Sierra Leone; Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone

Many countries in Africa, including Sierra Leone, have adopted artemisinin-based combination therapy as first-line therapy for treatment of patients with malaria. Because laboratory testing is often unavailable in rural areas, the cost-benefit and viability of this approach may depend on accurately diagnosing malaria by using clinical criteria. We assessed the accuracy of syndromic diagnosis for malaria in three peripheral health units in rural Sierra Leone and determined factors that were associated with an accurate malaria diagnosis. Of 175 children diagnosed with malaria on syndromic grounds, 143 (82%) were confirmed by the Paracheck-Pf test. In a multivariate analysis, splenomegaly (P = 0.04) was the only clinical sign significantly associated with laboratory-confirmed malaria, and sleeping under a bed net was protective (P = 0.05). Our findings show that clinical malaria is diagnosed relatively accurately in rural Sierra Leone. Incorporating bed net use and splenomegaly into the national Integrated Management of Childhood Illness guidelines for evaluation of fever may further enhance diagnostic accuracy for malaria.

Author Notes

*Address correspondence to Obinna N. Nnedu, Division of Infectious Diseases, Department of Medicine, University of Washington, 325 Ninth Avenue, PO Box 359909, Seattle, WA 98104. E-mail: onnedu@u.washington.edu

Financial support: This study was supported by Tulane School of Public Health and Tropical Medicine, New Orleans, LA, and the Louisiana Vaccine Center/South Louisiana Institute for Infectious Disease Research sponsored by the Louisiana Board of Regents.

Authors' addresses: Obinna N. Nnedu, Division of Infectious Diseases, Department of Medicine, University of Washington Seattle, WA, E-mail: onnedu@u.washington.edu. Bryan Rimel, Department of Medicine, Tulane University Health Sciences Center, New Orleans, LA, E-mail: brimel@tulane.edu. Carey Terry, Department of Family Medicine, University of Tennessee, Memphis, TN, E-mail: cterry3@utmem.edu. Heidi Jalloh-Vos, Medical Research Centre, Congo Cross, Freetown, Sierra Leone, E-mail: hjallohvos@hotmail.com. Brima Baryon, c/o District Health Management Team, EDC Unit, Bo, Sierra Leone. Daniel G. Bausch, Department of Tropical Medicine, SL-17, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, E-mail: dbausch@tulane.edu.

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