Abstract
ObjectivesParasitological confirmation of malaria prior to treatment is recommended for patients of all ages, with malaria rapid diagnostic tests (mRDTs) an important tool to target artemisinin-based combination therapies (ACTs) to patients with malaria. To evaluate the impact on case management practices of routine government implementation of mRDTs, we conducted large-scale health facility surveys in three regions of Tanzania before and after mRDT roll-out.MethodsFebrile patients at randomly selected health facilities were interviewed about care received at the facility, and blood samples were collected for reference blood smears. Health facility staff were interviewed about their qualifications and availability of malaria diagnostics and drugs.ResultsThe percentage of febrile patients tested for malaria at the facility increased from 15.8% in 2010 to 54.9% in 2012. ACTs were obtained by 65.8% of patients positive by reference blood smear in 2010 and by 50.2% in 2012 (P = 0.0675); no antimalarial was obtained by 57.8% of malaria-negative patients in 2010 and by 82.3% in 2012 (P < 0.0001). Overall, ACT use decreased (39.9–21.3%, P < 0.0001) and antibiotic use increased (31.2–48.5%, P < 0.0001).ConclusionRoll-out of mRDTs in Tanzania dramatically improved diagnostic testing for malaria and reduced overuse of ACTs for patients without parasitemia. However, post–roll-out almost 50% of febrile patients did not receive a diagnostic test, and almost 50% of patients testing positive did not receive ACTs. Stock-outs of ACTs and mRDTs were important problems. Further investigation is needed to determine reasons for not providing ACTs to patients with malaria and potential for inappropriate antibiotic use.
Highlights
Artemisinin-based combination therapies (ACTs) are the first-line drugs for malaria in most endemic countries, but there are concerns that targeting of ACTs to those in need remains poor
We have reported on the availability and use of diagnostic testing among febrile patients and case management with ACTs based on facility test results and reference blood smears, and we have examined the effect of this policy change on prescription of antibiotics
Malaria rapid diagnostic test roll-out in Tanzania led to substantial changes in the provision of malaria case management in public facilities
Summary
Artemisinin-based combination therapies (ACTs) are the first-line drugs for malaria in most endemic countries, but there are concerns that targeting of ACTs to those in need remains poor. Because microscopic testing of malaria has been limited in availability and is often of poor quality (McMorrow et al 2008; Drakeley & Reyburn 2009; Kahama-Maro et al 2011), it has been standard practice to diagnose malaria presumptively based on fever, resulting in over-treatment with antimalarials and under-treatment of non-malarial infections (Reyburn et al 2004; D’Acremont et al 2009) Such non-malarial febrile illnesses in a minority of cases are caused by bacterial infections but are most often due to self-limiting viral illnesses (Mtove et al 2011; Leslie et al 2012; McMorrow et al 2012). Parasitological confirmation of malaria prior to treatment is recommended for patients of all ages by World Health Organization (2010), with mRDTs an important part of the ‘T3: Test, Treat, Track’ initiative to ensure that every suspected malaria case is tested and every confirmed case is treated
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
