Influence of rapid malaria diagnostic tests on treatment and health outcome in fever patients, Zanzibar: a crossover validation study
Authors
Msellem, Mwinyi IMårtensson, Andreas
Rotllant, Guida
Bhattarai, Achuyt
Strömberg, Johan
Kahigwa, Elizeus
Garcia, Montse
Petzold, Max
Olumese, Peter
Ali, Abdullah
Björkman, Anders
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, SwitzerlandIssue Date
2009-04-28Submitted date
2010-10-15
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PLoS MedicineAbstract
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.PubMed ID
19399156Additional Links
http://dx.plos.org/10.1371/journal.pmed.1000070Type
ArticleLanguage
enISSN
1549-1676ae974a485f413a2113503eed53cd6c53
10.1371/journal.pmed.1000070
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