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Open Access Highly Accessed Opinion

Presumptive treatment of fever cases as malaria: help or hindrance for malaria control?

Roly D Gosling1*, Christopher J Drakeley1, Alex Mwita2 and Daniel Chandramohan1

Author Affiliations

1 Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK

2 National Malaria Control Program, Ministry of Health, P.O.Box 9083, Dar es Salaam, Tanzania

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Malaria Journal 2008, 7:132  doi:10.1186/1475-2875-7-132

Published: 16 July 2008

Abstract

Background

Malaria incidence has been reported to be falling in several countries in sub-Saharan Africa in recent years. This fall appears to have started before the widespread introduction of insecticide-treated nets. In the new era of calls to eliminate and eradicate malaria in sub-Saharan Africa, exploring possible causes for this fall seem pertinent.

Presentation of the hypothesis

The authors explore an argument that presumptive treatment of fever cases as malaria may have played a role in reducing transmission of malaria by the prophylactic effect of antimalarials and their widespread use. This strategy, which is already in practise is termed Opportunistic Presumptive Treatment (OPT).

Testing the hypothesis

Further comparison of epidemiological indicators between areas with OPT and more targeted treatment is required. If data suggest a benefit of OPT, combining long acting antimalarials that have an anti-gametocyticidal activity component plus using high levels of vector control measures may reduce transmission, prevent resistant strains spreading and be easily implemented.

Implications of the hypothesis

OPT is practised widely by presumptive treatment of fever in health facilities and home management of fever. Improving diagnosis using rapid diagnostic tests and thus reducing the number of doses of antimalarials given may have counter intuitive effects on transmission in the context of elimination of malaria in high to moderate transmission settings.