COMMUNITY-BASED DIAGNOSIS AND MANAGEMENT OF CHILDHOOD MALARIA USING RAPID DIAGNOSTIC TEST AND MANAGEMENT WITH ARTEMISININ –BASED COMBINATION THERAPY IN TARABA STATE-NIGERIA


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TABLE OF CONTENTS

Title page
Certification
Dedication
Acknowledgements
Table of contents
Lists of tables
Lists of figures
Abstract

CHAPTER ONE: INTRODUCTION AND LITERATURE REVIEW
1.1       Introduction
1.1.1    Significance of the study
1.1.2    General objective of the study
1.1.2.1 Specific research objectives
1.2       Literatures Review
1.2.1    History of malaria
1.2.2    Etiology and risk factors
1.2.3    Prevalence of malaria
1.2.4    Epidemiology of malaria
1.2.5    Transmission and life cycle of malaria
1.2.5.1 Vector in Nigeria and their breeding sites
1.2.5.2 Transmission pattern
1.2.5.3 Life cycle
1.2.6    Pathogenesis
1.2.7    Global burden of malaria
1.2.8    Diagnosis of malaria
1.2.8.1 Clinical and presumptive diagnosis
1.2.8.2 Rapid diagnostic tests (RDTs)
1.2.8.3 Microscopy
1.2.8.4 Polymerase chain reaction (PCR) for diagnosis of malaria
1.3       Malaria Chemotherapy
1.3.1    History of malaria chemotherapy
1.3.2    Efficacy of artemisinin based combination chemotherapy
1.4       Perception, Seeking Behaviour and Malaria Management
1.4.1    Prevention and control of malaria
1.4.2    Insecticides treated nets and  indoor residual spraying
1.4.3    Integrated control of malaria

CHAPTER TWO: MATERIALS AND METHODS
2.1       Study Area
2.2       Study Population
2.2.1    Inclusion and exclusion criteria
2.3       Study Design
2.4       Familiarization and Advocacy
2.4.1    Mobilization and training
2.4.2    Administration of questionnaires
2.5       Collection of Retrospective Malaria Survey (2009 - 2012)
2.6       Parasitological Procedures
2.6.1    RDT and microscopy
2.7       Administration of Artesunate-Amodiaquine
2.8       Adherence of Treatment Regime
2.9       Ethical Considerations
2.10     Data Analysis

CHAPTER THREE: RESULTS
3.1       Characteristics of Study Population
3.2       Prevalence of Malaria Infection Using Community-based Diagnosis and Microscopy
3.3       Community and Clinic-based Intensity of Malaria Parasitaemia
3.4       Comparison between RDT and Medical Laboratory Scientists Presumptive Diagnosis of Childhood Malaria
3.5       Reliability of Using Medical Laboratory Scientists Presumptive Diagnosis as Alternative to Paracheck RDT
3.6       Reliability of Using Caregivers Presumptive Diagnosis of Childhood Malaria in Comparison with Microscopy in Taraba State – Nigeria
3.7       Reliability of Using Caregivers Presumptive Diagnosis of Malaria to the Paracheck RDTs in Screening Childhood Malaria in Taraba State
3.8       General Diagnostic Performance of Paracheck RDT and Presumptive Diagnosis
3.9       Performance of Paracheck RDT and Presumptive Diagnosis at Different Parasite Levels
3.10     Performance of Paracheck RDT and Presumptive Diagnosis in Detection of Malaria Parasites According to Age-groups
3.11   Performance of Paracheck RDT and Presumptive Diagnosis in Relation to Sex
3.12     Validity of Medical Laboratory Scientists Presumptive Diagnosis as Alternative to Paracheck RDT
3.13   Diagnostic Accuracy of Caregivers Presumptive Diagnosis
3.14     Outcome of Treatment of Childhood Malaria after Seven Days of Treatment of Children with Artesunate-Amodiaquine in Taraba State
3.15     Malaria Parasitaemia Outcome in Relation to Sex, Age and LGAs after Drug Administration
3.16     Level of Adherence to Artesunate-Amodiaquine Treatment in Taraba State
3.17     Comparison between Reviewed Peripheral Blood Film and Intradermal Smear
3.18     Retrospection of Childhood Malaria
3.19     Knowledge of Malaria in Relation to Age and Occupation
3.20     Knowledge of Malaria Symptoms
3.21     Knowledge of Malaria Transmission
3.22     Treatment Preference by the Local Community
3.23     Treatment Preference of Members of the Community

CHAPTER FOUR: DISCUSSION
4.1       Prevalence and Intensity of Childhood Malaria
4.2       Reliability of Paracheck RDT and Presumptive Methods for Diagnosis of Malaria in Children by Medical Laboratory Scientists
4.3       Reliability and Validity of Caregiver’s Presumptive Diagnosis of Malaria in Children
4.4       Validity (Performance) of Paracheck RDT and Medical Laboratory Scientists Presumptive Diagnosis of Malaria in Children
4.5       Treatment Outcomes
4.6       Adherence to Treatment Regimen with Artesunate-Amodiaquine in Taraba State, Nigeria
4.7       Comparison of the Sensitivity of Intradermal Smear with Peripheral Blood Film (PBF) in Detection of Malaria Parasites in Children following Treatment with ACT
4.8       Retrospection Survey of Malaria Infection in Children from 2009 – 2011 in Communities in Taraba St ate
4.9       Knowledge of Malaria in Relation to Age and Occupation
4.10     The Knowledge of Malaria Symptoms among Community members in Taraba State
4.11     Knowledge of Malaria Transmission among Community Members in Taraba State
4.12   Treatment Preference for Malaria by the Community Members in Taraba State
4.13     Types of Malaria Treatments Sought for by the Local Community Members in Taraba State
Conclusion
Recommendations
References
Appendix




ABSTRACT

A cross-sectional study was conducted for fifteen (15) months (May, 2012 to July, 2013) to assess the efficacy of Rapid Diagnostic Test (RDT) in diagnosis followed by treatment of childhood malaria with Artemisinin - Based Combination Therapy (ACT) at community level in Taraba State. A total of 840 symptomatic children aged two months to thirteen years were presented for diagnosis with RDT kits by care givers at the designated clinics and at community levels. The 656 RDT positive children recorded in this study were treated with Artesunate-Amodiaquine. Microscopic slides of the blood of all the children presented for RDT were equally prepared and examined. Another 333 symptomatic children aged 2 months to thirteen years served as control in one clinic. All positive cases were reviewed, seven days after drug administration. Three hundred and nine (309) RDT positive children were followed-up for adherence to treatment regime. Intradermal smear and peripheral blood films were prepared for 59 children previously confirmed to be positive and were examined after treatment. Semi-structured questionnaires were administered to determine the perception of malaria and treatment preference of community. An overall malaria community microscopic confirmatory prevalence of 87.7% was recorded for the children. RDT/community based study recorded a cure rate of 88.2% with a prevalence reduction from 78.1% to 11.8%. There

was a significant reduction in the malaria parasitaemia (χ2 = 6.97 p = 0.031). A sensitivity and specificity of 85.62% and 75.73% with confidence interval (C.I.) of [83.08 – 88.15] and [67.45 – 84.01] were recorded for paracheck RDT res pectively. The positive predictive values recorded for RDT and presumptive diagnosis by medical laboratory scientists were 96.19 and 91.75 and their negative predictive values were 42.39 and 73.08 respectively. Paracheck RDT was found to have slightly higher K agreement to microscopy than presumptive diagnosis of malaria by medical laboratory scientists (0.458/0.445) Clinic/microscopy based diagnosis followed by administration of Artesunate-Amodiaquine.....



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