OUTCOME OF PRESUMP TIVE VERSUS RAP ID DIAGNOSTIC TESTS-BASED MANAGEMENT OF CHILDHOOD MALARIA – PNEUMONIA OVERLAP IN URBAN NIGERIA A PILOT QUASI- EXPERIMENTAL STUDY

Abstract

BACKGROUND: Symptoms of malaria and pneumonia overlap in African under-five children and the integratedmanagement of childhood illness strategy require that such children be managed presumptively with bothantibiotics and antimalarials. A 2003 WHO expert meeting recommended the evaluation of malaria rapiddiagnostic test in the management of children with this overlap, but this has not been evaluated. Therefore, theobjective of this study was to compare the clinical outcome of presumpt ive versus malaria rapid diagnostic test -based management of childhood malaria-pneumonia overlap in Nigeria.METHODS: A pilot quasi-experimental study was conducted November 2009 through February 2010 in an urbancomprehensive health centre i n Ogun, Sout h-Western Nigeria. First, 50 children with malaria-pneumonia symptomoverlap were consecutively enrolled and treated presumptively with antibiotics and antimalarials irrespective ofmalaria test result (control arm).Then, another 50 eligible children were e nrolled and treated with antibioticswith/out antimalarials based on rapid diagnostic test result (intervention arm). Primary endpoint: clinical cure atday-5. The data were analyzed using Epi Info version 3.4.1.RESULTS: The intervention and control arms did not differ significantly regarding patient demographic andclinical characteristics. Clinical cure rate was slightly higher in children managed presumptively 49 (98%) thanthose managed rapid diagnostic test -based 47 (94%) (P = 0.31). However, rapid diagnostic test -based treatedchildren had lower risk of receiving antimalarials compared to those treated presumptively (48% vs. 100%), (P =<0.001; relative risk 2.08, CI 1.56 to 2.78). No death or severe complications were recorded in either group at d ay-5follow-up.CONCLUSION: Outcome of rapid diagnostic test-based treatment is not inferior to presumptive management inchildren with malaria-pneumonia symptom overlap. More extensive studies with larger sample sizes are needed.