Abstract
BackgroundA rapid diagnostic tool is being developed to discern severely ill children with severe malaria from children who are ill with alternative febrile diseases but have coincidental peripheral blood parasitaemia. The device semi-quantitatively measures plasma pfHRP2 and has the potential to reduce mortality in children with severe febrile illnesses by improving diagnosis. The aim of this study is to identify contributing and inhibiting factors that affect healthcare practitioners’ acceptability of this prospective diagnostic device in a high malaria transmission setting in the Democratic Republic of Congo.MethodsData were collected qualitatively by conducting semi-structured interviews with a purposeful sample of health professionals in Kinshasa, capital of Democratic Republic of Congo. In total, 11 interviews were held with professionals at four different institutes.ResultsFour key findings emerged: (1) Congolese practitioners perceive the semi-quantitative pfHRP2 device as a welcome intervention as they recognize the limited reliability of their current diagnostic and therapeutic approaches to severe febrile illnesses; (2) compatibility of the semi-quantitative pfHRP2 device with clinical equipment and competences of Congolese health practitioners is considered to be limited, especially in rural settings; (3) a formal training programme is crucial for correct understanding and application of the semi-quantitative pfHRP2 device; and, (4) provision of evidence to practitioners, and support from health authorities would be important to establish confidence in the semi-quantitative pfHRP2 device.ConclusionsCongolese practitioners perceive the prospective semi-quantitative pfHRP2 device as a welcome addition to their clinical equipment. The device could improve current diagnostic work-up of severe febrile illness, which might consequently improve treatment choices. However, despite this recognized potential, several hurdles and drivers need to be taken into account when implementing this device in DR Congo.
Highlights
A rapid diagnostic tool is being developed to discern severely ill children with severe malaria from children who are ill with alternative febrile diseases but have coincidental peripheral blood parasitaemia
The illness is concomitant to an alternative but undetected infection whilst presence of the malaria parasites is coincidental. This is frequent in high transmission areas where children develop immunity to Plasmodium falciparum parasites during the early years of life or where they experience an extended period of parasite positivity after effective treatment of a recent malaria episode [7, 8]
Four key contributing factors were identified in the interviews with Congolese health professionals: (1) the semi-quantitative P. falciparum histidine-rich protein 2 (pfHRP2) device is perceived as an intervention with potential to improve management of children with febrile illness; (2) the device is considered to have limited compatibility with equipment and competences of Congolese practitioners, especially of those active in rural settings; (3) a formal training programme is crucial for correct application and interpretation of the semi-quantitative pfHRP2 device; and, (4) credible evidence provided to practitioners, but supported by health authorities, would establish confidence in the device
Summary
A rapid diagnostic tool is being developed to discern severely ill children with severe malaria from children who are ill with alternative febrile diseases but have coincidental peripheral blood parasitaemia. The illness is concomitant to an alternative but undetected infection whilst presence of the malaria parasites is coincidental This is frequent in high transmission areas where children develop immunity to Plasmodium falciparum parasites during the early years of life or where they experience an extended period of parasite positivity after effective treatment of a recent malaria episode [7, 8]. These semi-immune children can tolerate parasitaemia, but remain asymptomatic despite carrying parasite burdens detectable with microscopy or RDT. When malaria is detected in a febrile child, the health practitioner will obviously begin anti-malarial treatment, neglecting the high a priori chance that such a child is parasitaemic due to background prevalence
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