changing malaria epidemiology and diagnostic criteria for plasmodium falciparum clinical malaria改变疟疾流行病学和临床恶性疟原虫疟疾诊断标准.pdfVIP

Changing Malaria Epidemiology and Diagnostic Criteria for Plasmodium falciparum Clinical Malaria ´ 1 2,3 1 1 2 Clementine Roucher , Christophe Rogier , Fambaye Dieye-Ba , Cheikh Sokhna , Adama Tall , Jean- Franc¸ois Trape1* ´ ´ ´ 1 Institut de Recherche pour le Developpement, Laboratoire de Paludologie, UMR 198, BP 1386, Dakar, Senegal, 2 Institut Pasteur de Dakar, Unite d’Epidemiologie, B.P. 220, Dakar, Senegal, 3 Institut Pasteur de Madagascar, B.P. 1274, 101 Antananarivo, Madagascar Abstract Background: In tropical Africa, where malaria is highly endemic, low grade infections are asymptomatic and the diagnosis of clinical malaria is usually based on parasite density. Here we investigate how changes in malaria control and endemicity modify diagnostic criteria of Plasmodium falciparum attacks. Methods and Findings: Parasitological and clinical data from the population of Dielmo, Senegal, monitored during 20 years, are analyzed in a random-effect logistic regression model to investigate the relationship between the level of parasitemia and risk of fever. Between 1990 and 2010, P. falciparum prevalence in asymptomatic persons declined from 85% to 1% in children 0–3 years and from 34% to 2% in adults $50 years. Thresholds levels of parasitemia for attributing fever episodes to malaria decreased by steps in relation to control policies. Using baseline threshold during following periods underestimated P. falciparum attacks by 9.8–20.2% in children and 18.9–40.2% in adults. Considering all fever episodes