Study Of The Value Of Different Fever Related Syndromes For Screening Malaria Treatment Objects In Propagation Period

Objectives1.To find out the characters of patients with fever who visited the country doctors,analyze the relationships between these characters and the malaria onset.2.To build several fever related syndromes with selected clinical signs and symptoms of patients.Evaluate the values of these syndromes for screening the malaria treatment objects,and try to find the appropriate syndrome for guiding the malaria treatment practice,in order to treat malaria patients well and truly.MethodWe designed the "Registration form for patients with fever",well-trained country doctors use this form to inquire the patients whose body temperature were above 37.5℃,gathering information about signs,symptoms and epidemiologic characters of the patients,make standard blood film of the patients at the same time,blood film were sent to township hospital to be examed by microscopy.The microscopy examination results match the inquire form by an unique code.After the field work,we gathered all the inquire forms,inputed the data to computer and do statistic analyses by Excel 2003 and SPSS 14.0.We described epidemiologic characters and clinic manifestations of the patients with fever and do statistic analyses about the data,compared the distribution of these characters between malaria patients and non-malaria patients.We build several fever related syndromes with selected clinical signs and symptoms of patients by manual grouping and SPSS Stepwise Discriminate.Evaluating the syndromes by some index shuch as sensitivity and positive predictive value,and chose the relative appropriate symptom for screening the malaria treatment objects.ResultsWe totally got 1508 available samples,among them,there were 241 malaria patients.There were statistic differences of some epidemiologic characters between malaria patients and non-malaria patients such as using bed net,sleeping in open field and having malaria patients in family or neighbor recently,these characters are valuable references when the treatment objects been screened.All signs and symptoms in inquire form were appear.There are 13 manifestations showed differences between malaria patients and non-malaria patients, they were:body temperature above 39℃,periodic onset,chill,sweat,pale,muscle arthrosis pain,nausea or emesis,headache,cough,snivel,sore throat,diarrhea,night sweat.Build several syndromes with these 13 signs and symptoms by manual grouping and Stepwise Discriminate,analyzing the sensitivity and positive predictive value by analyze a curve of them,and calculating the integrate index such as likelihood ratio,Youden index and Kappa value.Based on these analyses we finally chose the syndrome "z"(body temperature above 39℃,periodic onset and non-diarrhea), its sensitivity and positive predictive value are 0.734 and 0.844.Syndrome "α"(body temperature above 39℃,periodic onset and non-snivel) have a relative high positive predictive value,so we regarded it as valuable in some cases.Conclusion1.Epidemiologic characters of the patients with fever are valuable references for screening malaria treatment objects such as bed net usage,sleeping in open field and having malaria patients in family or neighbor recently,the analysise of epidemiologic characters of malaria patients are meaningful to malaria control work.2.In the studied location,malaria patients have multiform clinical manifestations,it is different from the traditional "typical malaria onset",it is "typical" for single sign or symptom,and "un-typical" for general manifestation.3.We can build fever related syndromes by manual grouping and Stepwise Discriminate,the sensitivity and positive predictive value of syndrome "z" are 0.743 and 0.844,its our finally choice.Compared with the standardization of "Four Fever" which is now used as a basis for screening malaria treatment objects,syndrome "z" significantly improve the treatment efficiency,if been used in practical malaria control work,it will be significant.Otherwise,syndrome "α" has relative high positive predictive value,so it can be used as a auxiliary method in areas which have low malaria incidence rate.