Symptomatic identification of malaria in the home and in the primary health care clinic.

ABSTRACT

PIP: Over the past 30 years, the mountainous area of Kalinga Apayao Province on Luzon Island in the Philippines was extensively deforested due to slash and burn farming. The malaria risk is reduced, but malaria is still endemic. During 1990-1992, morbidity surveys identified 614 malaria cases. Researchers wanted to determine the accuracy, predictability, and reliability of clinical signs and symptoms for diagnosing malaria. Most individuals (89%) claimed to have had fever, yet just 35.4% had a body temperature greater than 37.6 degrees Celsius. Only 51.8% of fever cases had parasitemia, indicating that the World Health Organization's recommended case definition of malaria (i.e., presence or history of fever) did not adequately identify malaria. Further, prior to this study, about 50% of the area's children were usually infected, but just 11.3% of children younger than 6 in this study had fever. A good general predictor of malaria included a sequential occurrence of fever, chills and/or sweating, or a combination of all 3 symptoms. The positive predictive values were: at-home observation and diagnosis (74-76% vs. 69-72% at the rural health clinic), age younger than 9 years (80-84% vs. 65-69% for = or 10 year olds), and presentation during November-January (94-100% vs. 74% for February-October). November-January was the season when the prevalence of acute lower respiratory infections was highest. These results demonstrate that health workers can develop simple algorithms with good predictability of clinical signs and symptoms for high-risk groups to manage malaria in endemic areas of the Philippines.