Predictive Value of Fever and Palmar Pallor for P. falciparum Parasitaemia in Children from an Endemic Area 英文参考文献.docVIP

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Predictive Value of Fever and Palmar Pallor for P. falciparum Parasitaemia in Children from an Endemic Area 英文参考文献.doc

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Predictive Value of Fever and Palmar Pallor for P. falciparum Parasitaemia in Children from an Endemic Area 英文参考文献

PredictiveValueofFeverandPalmarPallorforP. falciparumParasitaemiainChildrenfromanEndemic Area ChristofDavidVinnemeier1*,NorbertGeorgSchwarz1,NimakoSarpong2,WibkeLoag1, SamuelAcquah2,BernardNkrumah2,FrankHuenger2,4,YawAdu-Sarkodie3,Ju¨rgenMay1 1InfectiousDiseaseEpidemiology,Bernhard-Nocht-InstituteforTropicalMedicine,Hamburg,Germany,2KumasiCentreforCollaborativeResearchinTropicalMedicine, Kumasi,Ghana,3SchoolofMedicalSciences,KwameNkrumahUniversityofScienceandTechnology,Kumasi,Ghana,4InstituteforTransfusionMedicine,Laboratory MedicineandMedicalMicrobiology,Dortmund,Germany Abstract Introduction:AlthoughtheincidenceofPlasmodiumfalciparummalariainsomepartsofsub-SaharanAfricaisreportedto decline and other conditions, causing similar symptoms as clinical malaria are gaining in relevance, presumptive anti- malarialtreatmentisstillcommon.Thisstudytracedforage-dependentsignsandsymptomspredictiveforP.falciparum parasitaemia. Methods:Intotal,5447visitsof3641patientsbetween2–60monthsofagewhoattendedanoutpatientdepartment(OPD) ofaruralhospitalintheAshantiRegion,Ghana,wereanalysed.AllChildrenwereexaminedbyapaediatricianandafull bloodcountandthicksmearweredone.AClassificationandRegressionTree(CART)modelwasusedtogenerateaclinical decisiontreetopredictmalarialparasitaemiaa7ndpredictivevaluesofallsymptomswerecalculated. Results:Malarialparasitaemiawasdetectedinchildrenbetween2–12monthsandbetween12–60monthsofagewitha prevalence of 13.8% and 30.6%, respectively. The CART-model revealed age-dependent differences in the ability of the variablestopredictparasitaemia.Whilepalmarpallorwasthemostimportantsymptominchildrenbetween2–12months,a reportoffeverandanelevatedbodytemperatureof$37.5uCgainedinrelevanceinchildrenbetween12–60months.The variable palmar pallor was significantly (p,0.001) associated with lower haemoglobin levels in children of all ages. Compared to the Integrated Management of Childhood Illness (IMCI) algorithm the CART-model had much lower sensitivities,buthigherspecific