Abstract
BackgroundWith the increase in use of point-of-care diagnostic tests for malaria and other diseases comes the necessity of storing the diagnostic kits and the drugs required for subsequent management, in remote areas, where temperatures are high and electricity supply is unreliable or unavailable.MethodsTo address the lack of temperature-controlled storage during the introduction of community-based malaria management in Cambodia, the Cambodian National Centre for Parasitology, Entomology and Malaria Control (CNM) developed prototype evaporative cooling boxes (Cambodian Cooler Boxes - CCBs) for storage of perishable medical commodities in remote clinics. The performance of these CCBs for maintaining suitable storage temperatures was evaluated over two phases in 2005 and 2006-7, comparing conditions in CCBs using water as designed, CCBs with no water for evaporation, and ambient storage room temperatures. Temperature and humidity was monitored, together with the capacity of the RDTs recommended for storage between 2 to 30 degree Celsius to detect low-density malaria parasite samples after storage under these conditions.ResultsSignificant differences were recorded between the proportion of temperatures within the recommended RDT storage conditions in the CCBs with water and the temperatures in the storage room (p < 0.001) and maximum temperatures were lower. RDTs stored at ambient temperatures were negative when tested with parasitized blood (2,000 parasites per micro litre) at 210 days, while the field RDTs kept in CCBs with water gave positive results until 360 days.Discussion and ConclusionsThe CCB was an effective tool for storage of RDTs at optimal conditions, and extended the effective life-span of the tests. The concept of evaporative cooling has potential to greatly enhance access to perishable diagnostics and medicines in remote communities, as it allows prolonged storage at low cost using locally-available materials, in the absence of electricity.
Highlights
With the increase in use of point-of-care diagnostic tests for malaria and other diseases comes the necessity of storing the diagnostic kits and the drugs required for subsequent management, in remote areas, where temperatures are high and electricity supply is unreliable or unavailable
These areas are malaria-endemic for both Plasmodium falciparum and Plasmodium vivax, and rapid diagnostic tests (RDTs) use used for malaria diagnosis
There were significant differences between the proportion of temperatures more than 30°C in the Cambodian Cooler Box” (CCB) with water compared with the corresponding temperature in the storage room (p < 0.001) in both sites while the cooler box without water provided some protection from high temperatures (Table 1 and Figure 3)
Summary
With the increase in use of point-of-care diagnostic tests for malaria and other diseases comes the necessity of storing the diagnostic kits and the drugs required for subsequent management, in remote areas, where temperatures are high and electricity supply is unreliable or unavailable. Since malaria rapid diagnostic tests (RDTs) were introduced in Cambodia in 1996, the use of the tests has increased steadily. The Cambodian programme uses RDTs to improve diagnosis of febrile illness in remote malaria-endemic areas where microscopy diagnostic services are not readily available. Rising treatment costs due to introduction of artemisinin-combination therapy (ACT) has further raised the importance of proper malaria diagnosis prior to treatment, and the urgency to reduce and eliminate emerging artemisinin-resistant malaria in western Cambodia has made rapid access, at community level, to both RDTs and anti-malarial drugs a priority for the Cambodian National Centre for Parasitology, Entomology and Malaria Control (CNM). Malaria RDTs are lateral-flow tests based on interactions of biological agents (antibodies and antigens) attached to or flowing along a nitro-cellulose strip. They are sensitive to degradation by heat and humidity. While exposure to humidity can be prevented by packaging in moisture-proof envelopes, if RDTs are stored at temperatures exceeding the recommended temperature it is likely that loss of sensitivity will occur and the shelf-life of the RDTs will be reduced [1]
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