Objectives

To investigate the consequence of restricting antimalarial treatment to febrile children that test positive to a malaria rapid diagnostic test (mRDT) only in an area of intense malaria transmission.

Methods

Febrile children aged 3–59 months were screened with an mRDT at health facilities in south-west Nigeria. mRDT-positive children received artesunate–amodiaquine (ASAQ), while mRDT-negative children were treated based on the clinical diagnosis of non-malaria febrile illness. The primary endpoint was the risk of developing microscopy-positive malaria within 28 days post-treatment.

Results

309 (60.5%) of 511 children were mRDT-positive while 202 (39.5%) were mRDT-negative at enrolment. 18.5% (50/275) of mRDT-positive children and 7.6% (14/184) of mRDT-negative children developed microscopy-positive malaria by day 28 post-treatment (q = 0.001). The risk of developing clinical malaria by day 28 post-treatment was higher among the mRDT-positive group than the mRDT-negative group (adjusted OR 2.74; 95% CI, 1.4, 5.4). A higher proportion of children who were mRDT-positive at enrolment were anaemic on day 28 compared with the MRDT-negative group (12.6% vs. 3.1%; q = 0.001). Children in the mRDT-negative group made more unscheduled visits because of febrile illness than those in mRDT-positive group (23.2% vs. 12.0%; q = 0.001).

Conclusion

Restricting ACT treatment to mRDT-positive febrile children only did not result in significant adverse outcomes. However, the risk of re-infection within 28 days was significantly higher among mRDT-positive children despite ASAQ treatment. A longer-acting ACT may be needed as the first-line drug of choice for treating uncomplicated malaria in high-transmission settings to
prevent frequent re-infections.

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Country: Nigeria