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Malaria dipsticks beneficial for IMCI in Cambodia
1Paediatric Research Centre, Tampere University Hospital, Tampere, Finland. marcus.rimon@uta.fi
Insights
The Integrated Management of Childhood Illness (IMCI) fever chart effectively identified malaria in young children. Malaria dipsticks proved valuable for IMCI case management in Cambodia.
Area of Science:
- Pediatric infectious diseases
- Public health interventions
- Malaria control strategies
Background:
- Cambodia introduced the Integrated Management of Childhood Illness (IMCI) approach and new malaria treatment guidelines for children under five.
- This study aimed to refine the malaria component of the national IMCI fever chart.
Purpose of the Study:
- To finalize the malaria management section of the national IMCI fever chart for children under five in Cambodia.
- To evaluate the effectiveness of a draft IMCI fever chart in identifying childhood malaria.
Main Methods:
- 323 children aged 2-59 months were studied in rural Cambodian health centers.
- Children with fever or anemia were tested for Plasmodium falciparum and Plasmodium vivax using dipsticks.
- Testing occurred in both high and low malaria transmission areas.
Main Results:
- The draft IMCI chart demonstrated high accuracy in identifying malaria, with a sensitivity of approximately 93% and specificity of 95%.
- Malaria dipsticks were confirmed as a viable tool for IMCI case management.
- The chart safely and effectively identified children with malaria.
Conclusions:
- The Cambodian Ministry of Health will implement the validated malaria chart during the IMCI Early Implementation Phase.
- Cost-effective dipsticks with high sensitivity for P. falciparum and P. vivax are crucial.
- The National Centre for Malaria Control should provide detailed risk area maps to guide dipstick use, especially in transitional zones.
Objectives:
The Integrated Management of Childhood Illness (IMCI) approach and new clinical treatment guidelines to control malaria among children less than 5 years old were introduced recently in Cambodia. This study was conducted to finalize the malaria part of the national IMCI fever chart.
Methods:
A total of 323 sick children 2-59 months old were studied at rural health centres in northern Cambodia from February to April 2000. Cases with fever (by axillary temperature or history) or anaemia (by palmar pallor) were tested with dipsticks for Plasmodium falciparum and Plasmodium vivax in high and low malaria risk areas and, if positive, treated with anti-malarials.
Results:
The draft IMCI chart identified children with malaria safely and effectively (sensitivity 14 of 15, approximately 93% and specificity 292 of 308, approximately 95%). The study confirmed the potential of malaria dipsticks as a part of IMCI case management.
Conclusion:
The Cambodian Ministry of Health will use the studied malaria chart during the Early Implementation Phase of IMCI. Dipsticks able to detect P. falciparum and P. vivax with high sensitivity and acceptable cost will be needed for this purpose. To promote the rational use of dipsticks, the National Centre for Malaria Control, Parasitology and Entomology (Centre National de Malaridogie, Parasitologie et Entomologie, CNM) should list all known malaria risk areas in the country and prepare detailed local maps guiding case management especially in transitional zones.