Tuesday, March 17, 2015

Differential dengue diagnosis causes public health issues in W. Africa

As we mentioned today in review, it is important to keep in mind that dengue fever is not transmissible among humans -- it is transmitted solely from a bite from a carrier mosquito. Researchers have established for the first time dengue transmission is actually occurring locally from mosquitos to humans in Ghana, rather than simply treating patients who were treated elsewhere.

This is an important fact to craft public health policy around for a few reasons. First, as the authors of this study point out, it is customary in Ghanian slums to store water in containers which can serve as breeding grounds for dengue-carrying mosquitos. Moreover, the researchers suggest that misdiagnosis of several illness that boast a similar set of symptoms as dengue (i.e. "undifferentiated febrile illnesses") is occurring very frequently and is leading to misallocation of resources and poor healthcare delivery. These symptoms often include fever and headache patterns that can be characteristic of many diseases.

Specifically, when faced with these "undifferentiated febrile illnesses," most Ghanian healthcare professionals simply assume their patient has malaria and throw anti-malarials at the illness. This over-prescription of anti-malarials "puts evolutionary pressure on the malaria parasite that risks hastening its resistance to artemisinin-based combination therapy," said University of Miami assistant professor Justin Stoler, who lead the study.

Part of the reason that so many misdiagnoses occur is that clinics in Ghana often lack the equipment to conduct the sophisticated laboratory tests that can confirm the presence of dengue, instead relying on a physical exam. As the authors suggest, this could be one critical need that aid organizations should target.

--Shubha Raghvendra


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