ABSTRACT
The aim of this study was to determine the frequency of confirmed malaria among patients with fever in the central Highlands of Madagascar, the clinical utility of treating this fever, and the involvement of community general practitioners in improving malaria management. This descriptive, prospective study took place from July 1, 2009, through June 30, 2010. Patients consulting for fever were classified into 2 groups: the first (G1) included all children younger than 5 years and the second group (G2) children 5 years or older and adults. In G1, 1383 cases of fever included 145 (10.5%) confirmed cases of malaria. The corresponding numbers in G2 were 1172 and 276 (23.5%). The prevalence of malaria was highest between December and May. In G1, the main clinical signs associated with a positive rapid diagnostic test (RDT) were pallor, jaundice, seizures, and failure to eat. In G2, a positive RDT was associated with pallor, coma, and jaundice. Treatment of patients with positive RDTs was based on quinine (51%) or artemisinin-based combination therapy (49%). Malaria remains endemic in the central Highlands of Madagascar. Efforts should be undertaken to improve prescription of antimalarial drugs.
Subject(s)
Malaria/diagnosis , Malaria/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Fever/etiology , General Practice , General Practitioners , Humans , Infant , Madagascar , Malaria/complications , Male , Middle Aged , Practice Patterns, Physicians' , Prospective Studies , Time Factors , Young AdultABSTRACT
In the past thirty years considerable effort has been devoted to delivering basic health services to rural populations. However the quality of care remains poor. One problem is that the absence of general practitioners working at the community level has resulted in health care systems without doctors. This "missing-link" situation is inconsistent with the availability of a large number of young fully trained medical doctors who graduated from Medical Schools in West African countries and Madagascar. Based on examples in Mali and Madagascar, the authors of this article attempt to show the advantages of a new concept, i.e., community-based general practitioners. These practitioners would not only provide a front-line medical presence but also combine the principles of primary health care (PHC) and family medicine (FM) into a single practice. For this approach to be successful a number of obstacles would have to be overcome and several indispensable accompanying measures would have to be implemented. The goal would be to establish a familiar front-line healthcare provider that village communities could trust.
