BACKGROUND:Malaria rapid diagnostic tests (RDTs) enable point-of-care testing to be nearly as sensitive and specific as reference microscopy. The Senegal National Malaria Control Programme introduced RDTs in 2007, along with a case management algorithm for uncomplicated febrile illness, in which the first step stipulates that if a febrile patient of any age has symptoms indicative of febrile illness other than malaria (e.g., cough or rash), they would not be tested for malaria, but treated for the apparent illness and receive an RDT for malaria only if they returned in 48 h without improvement.
METHODS:A year-long study in 16 health posts was conducted to determine the algorithm's capacity to identify patients with Plasmodium falciparum infection identifiable by RDT. Health post personnel enrolled patients of all ages with fever (≥37.5 °C) or history of fever in the previous 2 days. After clinical assessment, a nurse staffing the health post determined whether a patient should receive an RDT according to the diagnostic algorithm, but performed an RDT for all enrolled patients.
RESULTS:Over 1 year, 6039 patients were enrolled and 58% (3483) were determined to require an RDT according to the algorithm. Overall, 23% (1373/6039) had a positive RDT, 34% (1130/3376) during rainy season and 9% (243/2661) during dry season. The first step of the algorithm identified only 78% of patients with a positive RDT, varying by transmission season (rainy 80%, dry 70%), malaria transmission zone (high 75%, low 95%), and age group (under 5 years 68%, 5 years and older 84%).
CONCLUSIONS:In all but the lowest malaria transmission zone, use of the algorithm excludes an unacceptably large proportion of patients with malaria from receiving an RDT at their first visit, denying them timely diagnosis and treatment. While the algorithm was adopted within a context of malaria control and scarce resources, with the goal of treating patients with symptomatic malaria, Senegal has now adopted a policy of universal diagnosis of patients with fever or history of fever. In addition, in the current context of malaria elimination, the paradigm of case management needs to shift towards the identification and treatment of all patients with malaria infection.
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【Assessment of the utility of a symptom-based algorithm for identifying febrile patients for malaria diagnostic testing in Senegal.].
【评估基于症状的算法在塞内加尔识别高热患者进行疟疾诊断测试中的效用。】
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DOI：10.1186/s12936-017-1750-y文章类型：杂志文章
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背景：疟疾快速诊断测试（RDT）使即时检验与参考显微镜一样灵敏，特异。塞内加尔国家疟疾控制计划于2007年引入了RDTs，并提供了一种针对非复杂性高热疾病的病例管理算法，其中第一步规定，如果任何年龄的高热患者都有除疟疾以外的其他指示高热疾病的症状（例如，咳嗽或咳嗽或其他疾病）。皮疹），将不会对他们进行疟疾测试，而是对明显的疾病进行治疗，并且只有在48小时内没有改善的情况下，他们才能接受针对疟疾的RDT。
方法：在16个卫生站进行了为期一年的研究，以确定该算法对RDT可识别的恶性疟原虫感染患者的识别能力。卫生岗位人员招募了所有年龄在过去2天内发烧（≥37.5°C）或有发烧史的患者。经过临床评估后，派驻卫生岗位的护士根据诊断算法确定患者是否应接受RDT，但对所有入组患者均进行了RDT。
结果：在1年多的时间里，共有6039例患者入组，并根据算法确定有58％（3483）需要进行RDT。总体而言，RDT值为23％（1373/6039），雨季为34％（1130/3376），旱季为9％（243/2661）。算法的第一步仅确定78％的RDT阳性患者，随传播季节（多雨80％，干燥70％），疟疾传播区（高75％，低95％）和年龄段（5岁以下）而异岁68％，5岁及以上84％）。
结论：在除疟疾传播最低的地区以外的所有地区，该算法的使用都将不可接受的很大比例的疟疾患者排除在首次就诊时接受RDT的治疗，从而拒绝了他们及时的诊断和治疗。尽管在控制疟疾和资源匮乏的情况下采用了该算法，但以治疗有症状疟疾的患者为目标，塞内加尔现已采取了对发热或发热史患者进行普遍诊断的政策。另外，在当前消除疟疾的背景下，病例管理的模式需要转向识别和治疗所有疟疾感染患者。
方法：在16个卫生站进行了为期一年的研究，以确定该算法对RDT可识别的恶性疟原虫感染患者的识别能力。卫生岗位人员招募了所有年龄在过去2天内发烧（≥37.5°C）或有发烧史的患者。经过临床评估后，派驻卫生岗位的护士根据诊断算法确定患者是否应接受RDT，但对所有入组患者均进行了RDT。
结果：在1年多的时间里，共有6039例患者入组，并根据算法确定有58％（3483）需要进行RDT。总体而言，RDT值为23％（1373/6039），雨季为34％（1130/3376），旱季为9％（243/2661）。算法的第一步仅确定78％的RDT阳性患者，随传播季节（多雨80％，干燥70％），疟疾传播区（高75％，低95％）和年龄段（5岁以下）而异岁68％，5岁及以上84％）。
结论：在除疟疾传播最低的地区以外的所有地区，该算法的使用都将不可接受的很大比例的疟疾患者排除在首次就诊时接受RDT的治疗，从而拒绝了他们及时的诊断和治疗。尽管在控制疟疾和资源匮乏的情况下采用了该算法，但以治疗有症状疟疾的患者为目标，塞内加尔现已采取了对发热或发热史患者进行普遍诊断的政策。另外，在当前消除疟疾的背景下，病例管理的模式需要转向识别和治疗所有疟疾感染患者。
