Abstract
BackgroundWhile WHO recently recommended universal parasitological confirmation of suspected malaria prior to treatment, debate has continued as to whether wide-scale use of rapid diagnostic tests (RDTs) can achieve this goal. Adherence of health service personnel to RDT results has been poor in some settings, with little impact on anti-malarial drug consumption. The Senegal national malaria control programme introduced universal parasite-based diagnosis using malaria RDTs from late 2007 in all public health facilities. This paper assesses the impact of this programme on anti-malarial drug consumption and disease reporting.Methods and FindingsNationally-collated programme data from 2007 to 2009 including malaria diagnostic outcomes, prescription of artemisinin-based combination therapy (ACT) and consumption of RDTs in public health facilities, were reviewed and compared. Against a marked seasonal variation in all-cause out-patient visits, non-malarial fever and confirmed malaria, parasite-based diagnosis increased nationally from 3.9% of reported malaria-like febrile illness to 86.0% over a 3 year period. The prescription of ACT dropped throughout this period from 72.9% of malaria-like febrile illness to 31.5%, reaching close equivalence to confirmed malaria (29.9% of 584873 suspect fever cases). An estimated 516576 courses of inappropriate ACT prescription were averted.ConclusionsThe data indicate high adherence of anti-malarial prescribing practice to RDT results after an initial run-in period. The large reduction in ACT consumption enabled by the move from symptom-based to parasite-based diagnosis demonstrates that effective roll-out and use of malaria RDTs is achievable on a national scale through well planned and structured implementation. While more detailed information on management of parasite-negative cases is required at point of care level to assess overall cost-benefits to the health sector, considerable cost-savings were achieved in ACT procurement. Programmes need to be allowed flexibility in management of these funds to address increases in other programmatic costs that may accrue from improved diagnosis of febrile disease.
Highlights
The World Health Organization recently strengthened its recommendation for parasite-based diagnosis of malaria, extending it to all cases of suspected malaria prior to treatment with antimalarial medicines [1] Accurate diagnosis enables targeting of anti-malarial drugs to those who will benefit, early identification of non-malarial fever requiring alternative management, and accurate and complete surveillance for confirmed malaria cases
The large reduction in artemisinin-based combination therapies (ACT) consumption enabled by the move from symptom-based to parasite-based diagnosis demonstrates that effective roll-out and use of malaria rapid diagnostic tests (RDTs) is achievable on a national scale through well planned and structured implementation
While more detailed information on management of parasite-negative cases is required at point of care level to assess overall cost-benefits to the health sector, considerable cost-savings were achieved in ACT procurement
Summary
The World Health Organization recently strengthened its recommendation for parasite-based diagnosis of malaria, extending it to all cases of suspected malaria prior to treatment with antimalarial medicines [1] Accurate diagnosis enables targeting of anti-malarial drugs to those who will benefit, early identification of non-malarial fever requiring alternative management, and accurate and complete surveillance for confirmed malaria cases. Health care providers (and the communities they serve) must re-learn malaria diagnosis, but develop and implement new management strategies for the majority of febrile patients whose malaria test results will be negative. This poses a dilemma for resource-limited health services, as diagnostics for non-malarial febrile illness are often unavailable and management strategies limited. While WHO recently recommended universal parasitological confirmation of suspected malaria prior to treatment, debate has continued as to whether wide-scale use of rapid diagnostic tests (RDTs) can achieve this goal. This paper assesses the impact of this programme on anti-malarial drug consumption and disease reporting
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