# name
The impact of delayed treatment of uncomplicated P. falciparum
malaria on progression to severe malaria: A systematic review and a pooled multicentre individual-patient meta-analysis.

# metadata.dc.description.abstract[].value
Delay in receiving treatment for uncomplicated malaria (UM) is often
 reported to increase the risk of developing severe malaria (SM),
 but access to treatment remains low in most high-burden areas.
 Understanding the contribution of treatment delay on progression
                to severe disease is critical to determine how quickly patients
                need to receive treatment and to quantify the impact of widely
                implemented treatment interventions, such as 'test-and-treat'
                policies administered by community health workers (CHWs). We
                conducted a pooled individual-participant meta-analysis to
                estimate the association between treatment delay and presenting
                with SM. - Label: METHODS AND FINDINGS NlmCategory: RESULTS
                content: "A search using Ovid MEDLINE and Embase was initially
                conducted to identify studies on severe Plasmodium falciparum
                malaria that included information on treatment delay, such as
                fever duration (inception to 22nd September 2017). Studies
                identified included 5 case-control and 8 other observational
                clinical studies of SM and UM cases. Risk of bias was assessed
                using the Newcastle-Ottawa scale, and all studies were ranked as
                'Good', scoring \xE2\x89\xA57/10. Individual-patient data (IPD)
                were pooled from 13 studies of 3,989 (94.1% aged <15 years)
                SM patients and 5,780 (79.6% aged <15 years) UM cases in
                Benin, Malaysia, Mozambique, Tanzania, The Gambia, Uganda,
                Yemen, and Zambia. Definitions of SM were standardised across
                studies to compare treatment delay in patients with UM and
                different SM phenotypes using age-adjusted mixed-effects
                regression. The odds of any SM phenotype were significantly
                higher in children with longer delays between initial symptoms
                and arrival at the health facility (odds ratio [OR] = 1.33, 95%
                CI: 1.07-1.64 for a delay of >24 hours versus \xE2\x89\xA424
                hours; p = 0.009). Reported illness duration was a strong
                predictor of presenting with severe malarial anaemia (SMA) in
                children, with an OR of 2.79 (95% CI:1.92-4.06; p < 0.001)
                for a delay of 2-3 days and 5.46 (95% CI: 3.49-8.53; p <
                0.001) for a delay of >7 days, compared with receiving
                treatment within 24 hours from symptom onset. We estimate that
                42.8% of childhood SMA cases and 48.5% of adult SMA cases in the
                study areas would have been averted if all individuals were able
                to access treatment within the first day of symptom onset, if
                the association is fully causal. In studies specifically
                recording onset of nonsevere symptoms, long treatment delay was
                moderately associated with other SM phenotypes (OR [95% CI]
                >3 to \xE2\x89\xA44 days versus \xE2\x89\xA424 hours:
                cerebral malaria [CM] = 2.42 [1.24-4.72], p = 0.01; respiratory
                distress syndrome [RDS] = 4.09 [1.70-9.82], p = 0.002). In
                addition to unmeasured confounding, which is commonly present in
                observational studies, a key limitation is that many severe
                cases and deaths occur outside healthcare facilities in endemic
                countries, where the effect of delayed or no treatment is
                difficult to quantify." - Label: CONCLUSIONS NlmCategory:
                CONCLUSIONS content: Our results quantify the relationship
                between rapid access to treatment and reduced risk of severe
                disease, which was particularly strong for SMA. There was some
                evidence to suggest that progression to other severe phenotypes
                may also be prevented by prompt treatment, though the
                association was not as strong, which may be explained by
                potential selection bias, sample size issues, or a difference in
                underlying pathology. These findings may help assess the impact
                of interventions that improve access to treatment.

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
The impact of delayed treatment of uncomplicated P. falciparum
malaria on progression to severe malaria: A systematic review and a pooled multicentre individual-patient meta-analysis.