Paludisme observé chez les patients fébriles au Centre de Santé Materno-Infantile de Moramanga en 2007-2009

Introduction. In Madagascar, a fever is too often seen as synonymous with malaria. It is difficult to prevent self-medication with anti-malarial. Our objectives were to estimate the prevalence of malaria, to determine the frequency of self-medication with anti-malarial for fever and to identify the main signs of malaria. Methods. We conducted a retrospective study from June 2007 to May 2009 at CSMI in febrile patients. The variables studied were gender, age, residence, clinical signs, result of Rapid Diagnostic Test (RDT) and self-medication for malaria. Results. We enrolled 3710 patients. RDT has confirmed 139 cases of malaria (3.75%) aged 3 months to 59 years (mean = 9.73 years). In 58.27% of cases malarials were female (p>0.05). The age group of 1 to 5 years (47.48%) was the most affected (p>0.05). Plasmodium falci- parum was involved in 99.3% of cases (n=138). Patients in the suburbs represented 54.67% of malarials (p<0.001). The sensitivity and specificity of fever for the diagnosis of malaria were 61% and 50% respectively, and the PPV and NPV of 5% and 97%. Predictive clinical signs identified (p<0.05) were headache (32.37%), vomiting (24.46%) and chills (20.14%). Self-medication with anti-malarial was found in 8.46% (n=314). Conclusion. The prevalence of malaria was low. There are no specific signs of this disease. The most predictive signs of malaria were headache, vomiting and chills. Self-medication with anti-malarial remains a topical issue.