Use Of Malaria Rapid Diagnostic Tests Research Articles

Use of malaria rapid diagnostic test and anti-malarial drug prescription practices among primary healthcare workers in Ebonyi state, Nigeria: An analytical cross-sectional study.

The recommendation of universal diagnostic testing before malaria treatment aimed to address the problem of over-treatment with artemisinin-based combination therapy and the heightened risk of selection pressure and drug resistance and the use of malaria rapid diagnostic test (MRDT) was a key strategy, particularly among primary healthcare (PHC) workers whose access to and use of other forms of diagnostic testing were virtually absent. However, the use of MRDT can only remedy over-treatment when health workers respond appropriately to negative MRDT results by not prescribing anti-malarial drugs. This study assessed the use of MRDT and anti-malarial drug prescription practices, and the predictors, among PHC workers in Ebonyi state, Nigeria. We conducted an analytical cross-sectional questionnaire survey, among consenting PHC workers involved in the diagnosis and treatment of malaria, from January 15, 2020 to February 5, 2020. Data was collected via structured self-administered questionnaire and analysed using descriptive statistics and bivariate and multivariate generalized estimating equations. Of the 490 participants surveyed: 81.4% usually/routinely used MRDT for malaria diagnosis and 18.6% usually used only clinical symptoms; 78.0% used MRDT for malaria diagnosis for all/most of their patients suspected of having malaria in the preceding month while 22.0% used MRDT for none/few/some; 74.9% had good anti-malarial drug prescription practice; and 68.0% reported appropriate response to negative MRDT results (never/rarely prescribed anti-malarial drugs for the patients) while 32.0% reported inappropriate response (sometimes/often/always prescribed anti-malarial drugs). The identified predictor(s): of the use of MRDT was working in health facilities supported by the United States' President's Malaria Initiative (PMI-supported health facilities); of good anti-malarial drug prescription practice were having good opinion about MRDT, having good knowledge about malaria diagnosis and MRDT, being a health attendant, working in PMI-supported health facilities, and increase in age; and of appropriate response to negative MRDT results was having good opinion about MRDT. The evidence indicate the need for, and highlight factors to be considered by, further policy actions and interventions for optimal use of MRDT and anti-malarial drug prescription practices among the PHC workers in Ebonyi state, Nigeria, and similar settings.

Évaluation de la phase pilote de l’utilisation des tests de diagnostic rapide du paludisme au niveau communautaire, au Burkina Faso

Evaluation of the Pilot Phase of the Use of Rapid Malaria Diagnostic Tests at the Community Level in Burkina Faso : Introduction: According to the World Health Organization (WHO) guidelines, treatment for malaria should be carried out after diagnostic confirmation. At the community level, diagnostic confirmation by rapid diagnostic tests (RDTs) and treatment of malaria cases should be ensured by Community-Based Health Workers (ASBCs). This formative evaluation thus aimed to measure the level and quality of implementation of the pilot phase of the use of RDTs for malaria case confirmation at the community level in Burkina Faso from 2013 to 2015. Materials and methods: A multiple case study with multiple levels of analysis was conducted using a concurrent mixed approach in three health districts (Sapone, Nouna and Kaya). The quantitative approach consisted of administering a questionnaire to different groups of stakeholders (ASBCs, beneficiaries and health workers). The qualitative approach combined document review, individual interviews and focus groups with various key informants. The analysis of quantitative data was carried out using Stata version 15 and Excel 2007 software. A thematic content analysis was carried out using Nvivo 10.0 software for the qualitative data. A triangulation of the different quantitative and qualitative data was performed to deepen the analysis and validate some of our results. Results: The pilot phase of the use of RDTs for malaria at the community level was an intervention that was well accepted by the populations. The different components and activities of the intervention have been implemented. All ASBCs were trained in the use of RDTs. The integration of the supervision of ASBCs into the overall supervision of community activities was a positive aspect of the intervention. However, there were some difficulties in the implementation of each component of the intervention: not all the health and social promotion centres (CSPSs) in the three districts implemented this strategy to the same degree of adherence. In fact, difficulties were noted during the evaluation, such as the lack of RDTs and the existence of outdated stocks at the ASBCs, as well as the lack of security equipment. In addition, the monitoring of the intervention was limited by the poor quality of reporting of the activities carried out, due to the low level of education of most of the ASBCs and the weakness of supervision. Conclusion: The evaluation of the implementation of case confirmation by community-based RDTs in the health districts of Kaya, Nouna, and Sapone, shows that not all components were implemented with a high degree of adherence to the initial plan. The occurrence of a series of moderating factors that were not adequately supervised could partly explain this performance.

The effect of malaria rapid diagnostic tests results on antimicrobial prescription practices of health care workers in Burkina Faso

BackgroundMalaria rapid diagnostic tests (RDT) are widely used in endemic areas in order to comply with the recommendation that malaria treatment should only be given after the clinical diagnosis has been confirmed by RDT or microscopy. However, the overestimation of malaria infection with the use of PfHRP2 based RDT, makes the management of febrile illnesses more challenging. This study aimed to assess the effect of the use of malaria RDT on antimicrobial prescription practices.MethodsA prospective study was conducted among febrile children under-5 years of age attending four health facilities and the referral hospital in the Nanoro Health District (Burkina Faso). To assess the effect of malaria RDT testing on the prescriptions of antimicrobials in febrile children, the initial diagnosis and antimicrobial prescriptions following a malaria RDT testing were recorded. The necessity of these prescriptions was subsequently checked by assessing the actual cause of fever by expert malaria microscopy and a microbiology analysis of blood, urine, stool and nasopharynx swabs that were collected from febrile cases to determine the actual cause of the fever episode.ResultsMalaria was diagnosed by nurses, who are the primary health care providers, with a malaria RDT in 72.7% (798/1098) of febrile children, but only 53.7% (589/1097) cases could be confirmed by expert microscopy. Health care workers were likely to prescribe antimalarials to malaria positive RDT compared to malaria negative RDT (RR = 7.74, p = 0.00001). Malaria negative RDT result had a significant influence on the antibiotic prescriptions (RR = 3.57, p = 0.0001). The risk of prescribing antimicrobials was higher in health facility level compared to referral hospital. By cross-checking of laboratory findings to antimicrobial prescriptions, an important part of children with positive bacterial infection have received antibiotic prescriptions although the majority without any infection have also received antibiotics.ConclusionDespite the good attitude of health care workers to adhere to diagnostic test results, antimalarials and antibiotics remain inappropriate prescribed to febrile children. The low specificity of malaria RDT used could be an important cause of these practices.

Use of malaria RDTs in various health contexts across sub-Saharan Africa: a systematic review

BackgroundThe World Health Organization recommends parasitological confirmation of malaria prior to treatment. Malaria rapid diagnostic tests (RDTs) represent one diagnostic method that is used in a variety of contexts to overcome limitations of other diagnostic techniques. Malaria RDTs increase the availability and feasibility of accurate diagnosis and may result in improved quality of care. Though RDTs are used in a variety of contexts, no studies have compared how well or effectively RDTs are used across these contexts. This review assesses the diagnostic use of RDTs in four different contexts: health facilities, the community, drug shops and schools.MethodsA comprehensive search of the Pubmed database was conducted to evaluate RDT execution, test accuracy, or adherence to test results in sub-Saharan Africa. Original RDT and Plasmodium falciparum focused studies conducted in formal health care facilities, drug shops, schools, or by CHWs between the year 2000 and December 2016 were included. Studies were excluded if they were conducted exclusively in a research laboratory setting, where staff from the study team conducted RDTs, or in settings outside of sub-Saharan Africa.ResultsThe literature search identified 757 reports. A total of 52 studies were included in the analysis. Overall, RDTs were performed safely and effectively by community health workers provided they receive proper training. Analogous information was largely absent for formal health care workers. Tests were generally accurate across contexts, except for in drug shops where lower specificities were observed. Adherence to RDT results was higher among drug shop vendors and community health workers, while adherence was more variable among formal health care workers, most notably with negative test results.ConclusionsMalaria RDTs are generally used well, though compliance with test results is variable – especially in the formal health care sector. If low adherence rates are extrapolated, thousands of patients may be incorrectly diagnosed and receive inappropriate treatment resulting in a low quality of care and unnecessary drug use. Multidisciplinary research should continue to explore determinants of good RDT use, and seek to better understand how to support and sustain the correct use of this diagnostic tool.

Improving Access to Malaria Rapid Diagnostic Test in Niger State Nigeria: An Assessment of Implementation Up to 2013

Background: Nigeria adopted the WHO diagnosis and treatment guidelines within the framework of its 2009-2013 strategic plan, which included the use of Rapid Diagnostic Tests (RDTs) prior to prescribing malaria treatment with Artemisinin Combination Therapy (ACTs). This study explores accessibility barriers to the use of Malaria RDTs in Niger State, and formulates recommendations for improving the uptake of RDTs. Methods: Three strategies were adopted: 1) Literature review (both published and grey literature); 2) Review of data from the Niger State Health Management Information System for the period January-October 2013; 3) Application of a conceptual framework (Peters et al. 2008) for assessing access to health services.Results: Only 27 percent of public health facilities (HFs) implemented RDTs with the aid of donor funds. 77 percent of all fever cases presented in these HFs during January-October 2013 were tested with RDTs; 53 percent of all fever cases were confirmed cases of malaria; while 60 percent of all fever cases were treated. In 2013, 871,702 of ACTs were supplied as against 332,466 of RDTs. Private-sector presumptive treatments of malaria outnumber HFs treatment on the basis of RDT confirmation. Stockout of RDTs is the major constraint, and severe fever tends to trigger presumptive treatment.Conclusions: Implementation of RDTs led to a reduction in the use of ACTs at HFs. However, more substantial ACTs reduction could be achieved if the State Government directed more resources towards the acquisition of RDTs. Additionally, accessibility of RDTs is linked to the level of awareness of potential users about the service and its availability.

Bloodstream Infections and Malaria as Causes of Fever among Adult Medical Patients at a Referral Hospital in Malawi

Background and Aims: In Sub-Saharan Africa management of adult patients with febrile illness consists very often of empirical antibacterial and ant malarial treatment. This study examines the frequency, species identification and antibiotic susceptibility of bacterial Original Research Article International Journal of TROPICAL DISEASE & Health, 4(2): 182-193, 2014 183 isolates from blood and determines the frequency of malaria and the proportion of verified malaria cases among presumptively treated patients at a Malawian hospital. Study Design: This is a cross-sectional survey. Place and Duration of Study: Patients were enrolled at the Medical Department of Kamuzu Central Hospital, a referral hospital in Lilongwe, Malawi, between October 2010 and March 2011. Methodology: Patients ≥18 years with an axillary temperature ≥37.5°C were included. Blood cultures, malaria rapid diagnostic tests (RDTs), thick blood smears and HIV testing were performed. Results: 180 patients (58.3% female, median age: 31 years) were enrolled. Out of 157 patients, 89 (56.7%) tested HIV positive. Bacteremia was found in 19 (10.6%) patients including 6 (31.6%) Streptococcus pneumoniae, 6 (31.6%) Escherichia coli and 5 (26.3%) Salmonella enterica (4 Salmonella enterica serotype Typhimurium and 1 Salmonella enterica serotype Typhi). S. typhimurium and E. coli isolates showed frequent resistance to chloramphenicol, ampicillin and cotrimoxazole. Ceftriaxone was given to 110 (61.1%) patients. Malaria was confirmed by positive smear and/or positive RDT(s) in 57 (31.7%) cases. Presumptive antimalarial treatment was administered to 120 (66.7%) patients, however only 54 (45%) of these tested malaria positive. Conclusion: Empirical treatment of bloodstream infections should be based on antibiotic susceptibility of common local pathogens. Clinically suspected malaria should be confirmed by using malaria diagnostic testing before treatment. The use of malaria RDTs has to be carefully supervised and adherence to test results is advisable.

Malaria case management in Papua New Guinea following the introduction of a revised treatment protocol

BackgroundThis paper reports on the availability of diagnostic tools and recommended anti-malarials in the 12-month period immediately following the implementation of a new national malaria treatment protocol (NMTP) in Papua New Guinea (PNG). Health worker adherence to the new NMTP is also examined and comparisons made with previously reported pre-implementation findings.MethodsA countrywide cross-sectional survey in randomly selected primary health care facilities (n = 88). Data were collected via passive observation of the clinical case management of fever or suspected malaria patients and via an interviewer administered questionnaire completed with the officer in charge of each participating health care facility.ResultsMalaria rapid diagnostic tests (RDTs) and the new first-line anti-malarial medication, artemether-lumefantrine (AL), were available in 53.4% and 51.1% of surveyed heath facilities, respectively. However, they were more widely available in the larger health centres as compared to the smaller aid-posts (90.2% vs. 21.3% and 87.8% vs. 19.2%, respectively). Overall, 68.3% of observed fever cases (n = 445) were tested for malaria by RDT and 39% prescribed an anti-malarial, inclusive of 98.2% of RDT positive patients and 19.8% of RDT negative cases. The availability and use of malaria RDTs was greater in the current survey as compared to pre-implementation of the new NMTP (8.9% vs. 53.4% & 16.2% vs. 68.3%, respectively) as was the availability of AL (0% vs. 51.1%). The percentage of fever patients prescribed anti-malarials decreased substantially post implementation of the new NMTP (96.4% vs. 39.0%).ConclusionsPNG has achieved high coverage of malaria RDTs and AL at the health centre level, but these resources have yet to reach the majority of aid-posts. Malaria case management practice has substantially changed in the 12-month period immediately following the new NMTP, although full protocol adherence was rarely observed.

Malaria Rapid Diagnostic Tests

Global efforts to control malaria are more complex than those for other infectious diseases, in part because of vector transmission, the complex clinical presentation of Plasmodium infections, >1 Plasmodium species causing infection, geographic distribution of vectors and infection, and drug resistance. The World Health Organization approach to global malaria control focuses on 2 components: vector control and diagnosis and treatment of clinical malaria. Although microscopy performed on peripheral blood smears remains the most widely used diagnostic test and the standard against which other tests are measured, rapid expansion of diagnostic testing worldwide will require use of other diagnostic approaches. This review will focus on the malaria rapid diagnostic test (MRDT) for detecting malaria parasitemia, both in terms of performance characteristics of MRDTs and how they are used under field conditions. The emphasis will be on the performance and use of MRDTs in regions of endemicity, particularly sub-Saharan Africa, where most malaria-related deaths occur.

Malaria survey in post-earthquake Haiti--2010.

Haiti's Ministry of Public Health and Population collaborated with global partners to enhance malaria surveillance in two disaster-affected areas within 3 months of the January 2010 earthquake. Data were collected between March 4 and April 9, 2010 by mobile medical teams. Malaria rapid diagnostic tests (RDTs) were used for case confirmation. A convenience sample of 1,629 consecutive suspected malaria patients was included. Of these patients, 1,564 (96%) patients had malaria RDTs performed, and 317 (20.3%) patients were positive. Of the 317 case-patients with a positive RDT, 278 (87.7%) received chloroquine, 8 (2.5%) received quinine, and 31 (9.8%) had no antimalarial treatment recorded. Our experience shows that mobile medical teams trained in the use of malaria RDTs had a high rate of testing suspected malaria cases and that the majority of patients with positive RDTs received appropriate antimalarial treatment. Malaria RDTs were useful in the post-disaster setting where logistical and technical constraints limited the use of microscopy.

Major Reduction in Anti-Malarial Drug Consumption in Senegal after Nation-Wide Introduction of Malaria Rapid Diagnostic Tests

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.