Access to antimalarial therapy: accurate diagnosis is essential to achieving long term goals

Hopkins, Heidi; Asiimwe, Caroline; Bell, David S. H.

doi:10.1136/bmj.b2606

Cited by 37 publications

(35 citation statements)

References 23 publications

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“…1 As a result, mRDTs are now being integrated into community case management programmes [2][3][4] to mitigate against parasite resistance to antimalarial drugs and reduce waste associated with presumptive treatment. 5 However, although mRDTs are highly sensitive, 6 health workers still treat for malaria even after negative mRDT test results. 7,8 The fear that a child who has a false negative mRDT result may be sent home to deteriorate has been suggested as the reason why negative mRDT results are so often disregarded.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes among febrile children aged 2 to 59 months with negative malaria rapid diagnostic test results in Mchinji District, Malawi

Mwandama¹,

Mwale²,

Bauleni³

et al. 2017

Mal. Med. J

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BackgroundMalawi malaria treatment guidelines recommend a definitive diagnosis, using a malaria rapid diagnostic test (mRDT), for all patients with fever or history of fever. Improving the management and outcomes of febrile children with negative mRDT results should be a priority. MethodsThrough a prospective cohort study designed to investigate clinical outcomes of children treated at the community level, we followed, for 7 days, children aged 2 to 59 months, who had negative mRDT results and were treated with antipyretic medication. Clinical outcomes were assessed on days 3 and 7 post-recruitment.

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Section: Introductionmentioning

confidence: 99%

Clinical outcomes among febrile children aged 2 to 59 months with negative malaria rapid diagnostic test results in Mchinji District, Malawi

Mwandama¹,

Mwale²,

Bauleni³

et al. 2017

Mal. Med. J

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“…Timely testing and engagement into care among those infected with human immunodeficiency virus (HIV), tuberculosis (TB), and malaria and infection remains a large public health challenge in sub-Saharan Africa[1]–[3]. Testing is essential to starting the cascade of medical and behavioural interventions designed to improve a patient’s health and reduce their infectiousness [4]–[7].…”

Section: Introductionmentioning

confidence: 99%

Educational Intervention Increased Referrals to Allopathic Care by Traditional Healers in Three High HIV-Prevalence Rural Districts in Mozambique

et al. 2013

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IntroductionDelayed uptake of clinical services impedes favorable clinical outcomes in Mozambique. Care is delayed among patients who initiate care with traditional healers; patients with conditions like human immunodeficiency virus (HIV) or tuberculosis are rarely referred to the health system in a timely fashion.MethodsWe conducted a pre-post educational intervention with traditional healers, assessing healer referral rates and HIV knowledge in three rural districts in Zambézia Province.ResultsThe median monthly referral rate prior to the intervention was 0.25 patients (interquartile range [IQR]: 0–0.54) compared with a post-intervention rate of 0.34 patients (IQR: 0–0.71), a 35% increase (p = 0.046). A median HIV knowledge score of 67% (IQR: 59–78) was noted 4-months pre-intervention and a median score of 81% (IQR: 74–89) was recorded 2½ months post-intervention (p<0.001). One hundred and eleven healers referred 127 adults, 36 pregnant women, and 188 children to health facilities. Referred patients were most likely to be diagnosed with bronchopneumonia (20% adults; 13% children) and/or malaria (15% adults; 37% children). Of 315 non-pregnant persons referred, 3.5% were tested for HIV and 2.5% were tested for tuberculosis.DiscussionWe engaged traditional healers with some success; referral rates were low, but increased post-intervention. Once seen in the clinics, patients were rarely tested for HIV or tuberculosis, though symptoms suggested screening was indicated. We found increased referral rates through an inexpensive intervention with traditional healers, a viable, cost-effective method of directing patients to health facilities. However, quality improvement within the clinics is necessary before a substantial impact can be expected.

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“…Up to 90% of all malaria deaths occurred in Africa [1]. Parasite-based malaria diagnosis (PMD) has been shown to improve quality of care, reduce drug consumption [2] and enable early treatment of non-malaria febrile illness [3,4]. In 2009, 33 of 43 malaria-endemic countries in the African region reported having adopted a policy of providing parasitological diagnosis for all age groups [1] including scale up of rapid diagnostic tests (RDTs) at lower level health facilities (LLHF) where microscopy is not feasible.…”

Section: Introductionmentioning

confidence: 99%

Parasite-based malaria diagnosis: Are Health Systems in Uganda equipped enough to implement the policy?

et al. 2012

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BackgroundMalaria case management is a key strategy for malaria control. Effective coverage of parasite-based malaria diagnosis (PMD) remains limited in malaria endemic countries. This study assessed the health system's capacity to absorb PMD at primary health care facilities in Uganda.MethodsIn a cross sectional survey, using multi-stage cluster sampling, lower level health facilities (LLHF) in 11 districts in Uganda were assessed for 1) tools, 2) skills, 3) staff and infrastructure, and 4) structures, systems and roles necessary for the implementing of PMD.ResultsTools for PMD (microscopy and/or RDTs) were available at 30 (24%) of the 125 LLHF. All LLHF had patient registers and 15% had functional in-patient facilities. Three months’ long stock-out periods were reported for oral and parenteral quinine at 39% and 47% of LLHF respectively. Out of 131 health workers interviewed, 86 (66%) were nursing assistants; 56 (43%) had received on-job training on malaria case management and 47 (36%) had adequate knowledge in malaria case management. Overall, only 18% (131/730) Ministry of Health approved staff positions were filled by qualified personnel and 12% were recruited or transferred within six months preceding the survey. Of 186 patients that received referrals from LLHF, 130(70%) had received pre-referral anti-malarial drugs, none received pre-referral rectal artesunate and 35% had been referred due to poor response to antimalarial drugs.ConclusionPrimary health care facilities had inadequate human and infrastructural capacity to effectively implement universal parasite-based malaria diagnosis. The priority capacity building needs identified were: 1) recruitment and retention of qualified staff, 2) comprehensive training of health workers in fever management, 3) malaria diagnosis quality control systems and 4) strengthening of supply chain, stock management and referral systems.

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Access to antimalarial therapy: accurate diagnosis is essential to achieving long term goals

Abstract: Increased attention to and funding for malaria promises to improve access to effective treatment, but Heidi Hopkins, Caroline Asiimwe, and David Bell argue that without diagnostic testing much of this effort will be wasted

Cited by 37 publications

References 23 publications

Clinical outcomes among febrile children aged 2 to 59 months with negative malaria rapid diagnostic test results in Mchinji District, Malawi

Clinical outcomes among febrile children aged 2 to 59 months with negative malaria rapid diagnostic test results in Mchinji District, Malawi

Educational Intervention Increased Referrals to Allopathic Care by Traditional Healers in Three High HIV-Prevalence Rural Districts in Mozambique

Parasite-based malaria diagnosis: Are Health Systems in Uganda equipped enough to implement the policy?

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