Ruling out malaria infection in children in UK emergency departments

Malaria is a parasitic disease spread from mosquitoes to humans in tropical regions and remains a major cause of death in children worldwide https://www.who.int/health-topics/malaria#tab=tab_1 . Increasing numbers of children and young people (CYP) are travelling and imported malaria cases in the UK are once again on the rise post pandemic https://travelhealthpro.org.uk/news/716/malaria-imported-into-the-uk-2020-and-2021 .

The symptoms of malaria – fever, lethargy, cough, tummy and muscle pain among others – are non-specific so while only around 3 in 100 children who present to UK emergency departments likely have malaria, any child who has fever and who has returned from a malaria endemic area needs an urgent test to screen for the disease.

Click to expand

A newer rapid diagnostic test for malaria (RDT) is now used alongside microscopy in UK labs to screen for malaria and is a mainstay for malaria diagnosis in resource-limited settings. We looked at the data for over 1,400 children tested for malaria across 15 UK hospitals during 2016-17. Our study aimed to see whether an RDT alone, which is a quick and simple finger-prick test, can rule out malaria in children presenting to UK emergency departments.

We found that RDT alone was very good at ruling out the Plasmodium falciparum type of malaria (the type that is the main cause of death from malaria and which is found in over three quarters of cases imported to the UK) but not quite so good for other species, so we still need to use microscopy until more accurate tests are developed.

However, we believe the study’s results, the first to evaluate the accuracy of RDTs to rule out imported malaria in children, can still improve the patient journey:

• We found that malaria was accurately diagnosed in all but one case (1 out of 47) with an RDT and one microscopy test alone. We think that in a well-looking child, most children will not need to come back for repeat tests (which is what we found was happening with over four fifths of children tested anyway)
• We plan to trial taking the RDT out of the lab and use it in children’s emergency departments, aiming to make an earlier diagnosis and cut the time families spend in the emergency department (we will still need to send a sample for microscopy but most well-appearing children will not need to wait for the result)

You can read the full paper here: https://doi.org/10.1093/jpids/piad024

Click here to download a .pdf of the infographic.