Abstract
BackgroundThe WHO recommends that all suspect malaria cases be tested before receiving treatment. Rapid diagnostic tests (RDT) for malaria can be performed reliably by community health workers with no formal medical background and thus, RDTs could also be provided to travellers for self-diagnosis during visits to endemic regions.MethodsRDTs were proposed during pre-travel consultations to pre-defined categories of travellers. A training run on their own blood was performed and, if carried out correctly, the traveller was given a written procedure on how to perform the test and act on its result. The travellers were then proposed to buy a malaria RDT kit and were interviewed upon their return.ResultsFrom February 2012 to February 2017, 744 travellers were proposed RDTs and 692 performed the training run (one could not complete it due to a hand tremor). Among the 691 subjects included, 69% travelled to moderate- or low-risk areas of malaria, 18% to high-risk areas and 13% to mixed-risk areas. The two most frequent categories of travellers to whom RDTs were proposed were long-term travellers (69%) and those travelling to remote areas (57%). 543 travellers (79%) were interviewed upon return. During their trip, 17% (91/543) had a medical problem with fever and 12% (65/543) without fever. Among 91 febrile patients, 57% (52/91) performed an RDT, 22% (20/91) consulted immediately without using the test, and 21% (19/91) did neither. Four RDTs (4/52; 8%) were positive: 2 in low-risk and 2 in high-risk areas (0.7% attack rate of self-documented malaria). Two travellers could not perform the test correctly and attended a facility or took standby emergency treatment. Four travellers with negative results repeated the test after 24 h; all were still negative. Carrying RDTs made travellers feel more secure, especially when travelling with children.Conclusions1/6 travellers experienced fever and 4/5 of those reacted appropriately: more than half used RDTs and a quarter consulted immediately. Four travellers (including 2 from low-risk areas) diagnosed themselves with malaria and self-treated successfully. This strategy allows prompt treatment for malaria in high-risk groups and may avoid over-diagnosis (and subsequent inappropriate treatment) of malaria on-site.
Highlights
The WHO recommends that all suspect malaria cases be tested before receiving treatment
Rapid diagnostic tests (RDT) were primarily proposed to travellers planning to visit moderate- or low-risk malaria areas (i.e. to whom the Swiss guidelines on malaria prevention [12] recommend the use of standby emergency treatment (SBET) rather than chemoprophylaxis)
Between February 2012 and February 2017 RDTs were proposed to 744 travellers
Summary
The WHO recommends that all suspect malaria cases be tested before receiving treatment. Rapid diagnostic tests (RDT) for malaria can be performed reliably by community health workers with no formal medical background and RDTs could be provided to travellers for self-diagnosis during visits to endemic regions. Recent studies in non-endemic and endemic settings using PCR as reference test showed that sensitivity of RDTs is even higher than standard (but not necessarily expert) microscopy [4]. In 1999, Trachsler et al reported that a high proportion (14%) of travellers in a pre-travel setting was not able to interpret dipstick RDTs correctly despite receiving written instructions and/or oral explanations. Funk et al reported high levels of false-negative interpretation by travellers with MalaQuick® and ParaSight F® despite an information leaflet [6]. Jelinek et al showed that 31% of febrile travellers in Kenya failed to perform the dipstick test [7]. Self-testing by ill travellers has been studied by Whitty et al with 9% of travellers not being able to obtain a valid result; they concluded that clearer instructions were essential [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
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 call
