Influence of rapid malaria diagnostic tests on treatment and health outcome in fever patients, Zanzibar: a crossover validation study

Hdl Handle:
http://hdl.handle.net/10144/114022
Title:
Influence of rapid malaria diagnostic tests on treatment and health outcome in fever patients, Zanzibar: a crossover validation study
Authors:
Msellem, Mwinyi I; Mårtensson, Andreas; Rotllant, Guida; Bhattarai, Achuyt; Strömberg, Johan; Kahigwa, Elizeus; Garcia, Montse; Petzold, Max; Olumese, Peter; Ali, Abdullah; Björkman, Anders
Journal:
PLoS Medicine
Abstract:
BACKGROUND: The use of rapid diagnostic tests (RDTs) for Plasmodium falciparum malaria is being suggested to improve diagnostic efficiency in peripheral health care settings in Africa. Such improved diagnostics are critical to minimize overuse and thereby delay development of resistance to artemisinin-based combination therapies (ACTs). Our objective was to study the influence of RDT-aided malaria diagnosis on drug prescriptions, health outcomes, and costs in primary health care settings. METHODS AND FINDINGS: We conducted a cross-over validation clinical trial in four primary health care units in Zanzibar. Patients of all ages with reported fever in the previous 48 hours were eligible and allocated alternate weeks to RDT-aided malaria diagnosis or symptom-based clinical diagnosis (CD) alone. Follow-up was 14 days. ACT was to be prescribed to patients diagnosed with malaria in both groups. Statistical analyses with multilevel modelling were performed. A total of 1,887 patients were enrolled February through August 2005. RDT was associated with lower prescription rates of antimalarial treatment than CD alone, 361/1005 (36%) compared with 752/882 (85%) (odds ratio [OR] 0.04, 95% confidence interval [CI] 0.03-0.05, p<0.001). Prescriptions of antibiotics were higher after RDT than CD alone, i.e., 372/1005 (37%) and 235/882 (27%) (OR 1.8, 95%CI 1.5-2.2, p<0.001), respectively. Reattendance due to perceived unsuccessful clinical cure was lower after RDT 25/1005 (2.5%), than CD alone 43/882 (4.9%) (OR 0.5, 95% CI 0.3-0.9, p = 0.005). Total average cost per patient was similar: USD 2.47 and 2.37 after RDT and CD alone, respectively. CONCLUSIONS: RDTs resulted in improved adequate treatment and health outcomes without increased cost per patient. RDTs may represent a tool for improved management of patients with fever in peripheral health care settings. TRIAL REGISTRATION: (Clinicaltrials.gov) NCT00549003.
Affiliation:
Malaria Control Programme, Ministry of Health and Social Welfare, Zanzibar, Tanzania; Infectious Diseases Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Division of International Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm; Medecins Sans Frontieres, Dar es Salaam, Tanzania; World Health Organization (WHO) Country Office, Dar es Salaam, Tanzania; Nordic School of Public Health, Gothenburg, Sweden; Global Malaria Programme, WHO, Geneva, Switzerland
Issue Date:
28-Apr-2009
URI:
http://hdl.handle.net/10144/114022
DOI:
10.1371/journal.pmed.1000070
PubMed ID:
19399156
Additional Links:
http://dx.plos.org/10.1371/journal.pmed.1000070
Submitted date:
2010-10-15
Type:
Article
Language:
en
ISSN:
1549-1676
Appears in Collections:
Malaria

Full metadata record

DC FieldValue Language
dc.contributor.authorMsellem, Mwinyi Ien
dc.contributor.authorMårtensson, Andreasen
dc.contributor.authorRotllant, Guidaen
dc.contributor.authorBhattarai, Achuyten
dc.contributor.authorStrömberg, Johanen
dc.contributor.authorKahigwa, Elizeusen
dc.contributor.authorGarcia, Montseen
dc.contributor.authorPetzold, Maxen
dc.contributor.authorOlumese, Peteren
dc.contributor.authorAli, Abdullahen
dc.contributor.authorBjörkman, Andersen
dc.date.accessioned2010-10-29T15:20:40Z-
dc.date.available2010-10-29T15:20:40Z-
dc.date.issued2009-04-28-
dc.date.submitted2010-10-15-
dc.identifier.citationPLoS Med. 2009;6(4):e1000070en
dc.identifier.issn1549-1676-
dc.identifier.pmid19399156-
dc.identifier.doi10.1371/journal.pmed.1000070-
dc.identifier.urihttp://hdl.handle.net/10144/114022-
dc.description.abstractBACKGROUND: The use of rapid diagnostic tests (RDTs) for Plasmodium falciparum malaria is being suggested to improve diagnostic efficiency in peripheral health care settings in Africa. Such improved diagnostics are critical to minimize overuse and thereby delay development of resistance to artemisinin-based combination therapies (ACTs). Our objective was to study the influence of RDT-aided malaria diagnosis on drug prescriptions, health outcomes, and costs in primary health care settings. METHODS AND FINDINGS: We conducted a cross-over validation clinical trial in four primary health care units in Zanzibar. Patients of all ages with reported fever in the previous 48 hours were eligible and allocated alternate weeks to RDT-aided malaria diagnosis or symptom-based clinical diagnosis (CD) alone. Follow-up was 14 days. ACT was to be prescribed to patients diagnosed with malaria in both groups. Statistical analyses with multilevel modelling were performed. A total of 1,887 patients were enrolled February through August 2005. RDT was associated with lower prescription rates of antimalarial treatment than CD alone, 361/1005 (36%) compared with 752/882 (85%) (odds ratio [OR] 0.04, 95% confidence interval [CI] 0.03-0.05, p<0.001). Prescriptions of antibiotics were higher after RDT than CD alone, i.e., 372/1005 (37%) and 235/882 (27%) (OR 1.8, 95%CI 1.5-2.2, p<0.001), respectively. Reattendance due to perceived unsuccessful clinical cure was lower after RDT 25/1005 (2.5%), than CD alone 43/882 (4.9%) (OR 0.5, 95% CI 0.3-0.9, p = 0.005). Total average cost per patient was similar: USD 2.47 and 2.37 after RDT and CD alone, respectively. CONCLUSIONS: RDTs resulted in improved adequate treatment and health outcomes without increased cost per patient. RDTs may represent a tool for improved management of patients with fever in peripheral health care settings. TRIAL REGISTRATION: (Clinicaltrials.gov) NCT00549003.en
dc.language.isoenen
dc.relation.urlhttp://dx.plos.org/10.1371/journal.pmed.1000070en
dc.rightsPublished by Public Library of Science, [url]http://medicine.plosjournals.org/[/url] Archived on this site by Open Access permissionen
dc.subject.meshAdulten
dc.subject.meshAntimalarialsen
dc.subject.meshArtemisininsen
dc.subject.meshChilden
dc.subject.meshChild, Preschoolen
dc.subject.meshCross-Over Studiesen
dc.subject.meshDiagnostic Tests, Routineen
dc.subject.meshDrug Therapy, Combinationen
dc.subject.meshFeveren
dc.subject.meshHumansen
dc.subject.meshMalaria, Falciparumen
dc.subject.meshOdds Ratioen
dc.subject.meshPrescriptionsen
dc.subject.meshTanzaniaen
dc.subject.meshTreatment Outcomeen
dc.titleInfluence of rapid malaria diagnostic tests on treatment and health outcome in fever patients, Zanzibar: a crossover validation studyen
dc.typeArticleen
dc.contributor.departmentMalaria Control Programme, Ministry of Health and Social Welfare, Zanzibar, Tanzania; Infectious Diseases Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Division of International Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm; Medecins Sans Frontieres, Dar es Salaam, Tanzania; World Health Organization (WHO) Country Office, Dar es Salaam, Tanzania; Nordic School of Public Health, Gothenburg, Sweden; Global Malaria Programme, WHO, Geneva, Switzerlanden
dc.identifier.journalPLoS Medicineen

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