Mediterranean Journal of Hematology and Infectious Diseases

The revised W.H.O. guidelines for malaria management in endemic that treatment should be reserved to laboratory confirmed cases, both for adults and children. Currently the most widely used tools are rapid diagnostic tests (RDTs), that are accurate and reliable in diagnosing malaria infection. Howev and RDTs may give positive results in febrile patients who have another cause of fever. Excessive reliance on RDTs may cause overlooking potentially severe non malarial febrile illnesses (NMFI) in these cases. In countries or areas where transmission intensity remains very high, fever management in children (especially in the rainy season) should probably remain presumptive, as a test-based management may not be safe, nor cost effective. In contrast, i transmission, including those targeted for malaria elimination, RDTs are a key resource to limit unnecessary antimalarial prescription and to identify pockets of infected individuals. Research should focus on very sensitive tools for management on the other, including biomarkers of clinical malaria and/or of alternative causes of fever. Background. Malaria management policies in most sub-Saharan countries traditionally relied on presumptive diagnosis without laboratory confirmation, basically considering any fever as malaria, particularly in children, being the m vulnerable to acute malaria. This was basically due to the lack of laboratory facilities at the peripheral level of the health system (Primary Health Care or P.H.C.). The diagnosis was then barely clinical, and while over treatment was an obvious consequence, the rationale behind such empirical management was the need to www.mjhid.org ISSN 2035-3006 with or without Disease and Jef Van den Ende Cuore, Negrar (Verona), Italy d that no competing interests exist. 2, 4(1): e2012036, DOI: 10.4084/MJHID.2012.036 ), which permits unrestricted use, distribution, and reproduction in any medium,