[Malaria diagnosis and treatment in a rural Health Centre in Mayotte (Comoro archipelago, 2002)]

With a marked increase in both morbidity and mortality, as well as a high level of resistance to chloroquine (CQ), malaria is once again a major public health problem in Mayotte, a French overseas territory in the Comoro archipelago. The object of this study is to assess the contribution in the field of two new antimalarial fight steps taken in 2001-2002: The use of the rapid diagnostic test (RDT) for malaria OptiMAL in the rural health centres and the drop of the CQ alone for the simultaneous administration of CQ and sulfadoxine-pyrimethamine (SP) as the first-line treatment for uncomplicated malaria. All 581 suspected malaria attacks, diagnosed by RDT during the year 2002 in a rural health centre of the island, were registered. The good positive predictive value of the RDT used (97.2%) calculated during the study has permitted an important reduction of the rate of wrongly administer antimalarial treatment. Before RDT was used, through lack of emergency microscopic diagnosis, the antimalarial treatment was presumptive in the isolated health centres and that rate was superior to 90%. It is now below 3%. Before the introduction of the new protocol, in the middle of the year 2002, the rate of therapeutic failures with CQ used alone was 40.2% (33/82). With the simultaneous administration of CQ and SP as a first-line treatment, this rate fell down to 1.8% (6/337). For the time being, this new treatment policy is acceptable in Mayotte. But the experience of the countries who have adopted this therapeutic policy shows that the effectiveness of the association CQ-SP is likely to be temporary. It is necessary to set up a "durable long-term" therapy strategy in Mayotte as soon as possible by adopting as first-line treatment for uncomplicated malaria a combination therapy according to the recommendations of the World Health Organization. It could be the artemether-lumefantrine combination which has already been the subject of an efficacy survey in the island.