The Potential Impact of Improving Appropriate Treatment for Fever on Malaria and Non-Malarial Febrile Illness Management in Under-5s: A Decision-Tree Modelling Approach

摘要: As international funding for malaria programmes plateaus, limited resources must be rationally managed and non-malarial febrile illnesses (NMFI). Given widespread unnecessary treatment of NMFI with first-line antimalarial Artemisinin Combination Therapies (ACTs), our aim was to estimate the effect health-systems factors on rates appropriate fever use ACTs. A decision-tree tool developed investigate impact improving aspects care-pathway also evaluate in Tanzania revised WHO guidelines advocating diagnostic-led management. Model outputs using baseline parameters suggest 49% cases attending a clinic would receive ACTs (95% Uncertainty Interval:40.6-59.2%) but that 44% UI:35-54.8%) Provision 100% ACT stock predicted 28.9% increase treated ACT, an overtreatment NMFI, 70% UI:56.4-79.2%) projected ACTs, thus overall 13% reduction UI:5-21.6%) correct management cases. Modelling increased availability or diagnostics had little outputs, may significantly reduce overtreatment. The model predicts early rollout have led 35% decrease UI:31.2-39.8%) overtreatment, 19.5% UI:11-27.2%), receiving due potential fourfold were untested tested false-negative (42.5% vs.8.9%) so untreated. multi-pronged intervention strategies proved most effective improve without increasing transmission declines, health system interventions guided by whether priority is (reducing gap), reducing waste through expanding all illness.