Health Workers' Use of Malaria Rapid Diagnostic Tests (RDTs) to Guide Clinical Decision Making in Rural Dispensaries, Tanzania

Abstract

Rapid diagnostic tests (RDTs) were developed as an alternative to microscopy for malaria diagnosis. The RDTs detect malaria parasite antigen(s) in whole blood with high sensitivity and specificity. We assessed health worker malaria treatment practices after the introduction of RDTs in peripheral health facilities without microscopy. From December 2007 to October 2008, we introduced histidine-rich protein II (HRP-2)-based ParaHIT RDTs for routine use in 12 health facilities in Rufiji District, Tanzania. Health workers received training on how to perform RDTs for patients 5 years of age or older with fever or suspected malaria. Children < 5 years of age were to be treated empirically per national guidelines. Among the 30,195 patients seen at these 12 health facilities, 10,737 (35.6%) were tested with an RDT for malaria. 88.3% (9,405/10,648) of tested patients reported fever or history of fever and 2.7% (289/10,677) of all tested individuals were children < 5 years of age. The RDT results were recorded for 10,650 patients (99.2%). Among the 5,488 (51.5%) RDT-positive patients, 5,256 (98.6%) were treated with an appropriate first-line antimalarial per national guidelines (artemether-lumefantrine or quinine). Among the 5,162 RDT-negative patients, only 205 (4.0%) were treated with an antimalarial. Other reported treatments included antibiotics and antipyretics. Implementation of RDTs in rural health facilities resulted in high adherence to national treatment guidelines. Patients testing negative by RDT were rarely treated with antimalarials. Unapproved antimalarials were seldom used. Health workers continued to follow guidelines for the empiric treatment of febrile children.

Health workers’ compliance to rapid diagnostic tests (RDTs) to guide malaria treatment: a systematic review and meta-analysis

“…A pooled meta-analysis using random effects (Fig. 4 ) for the 14 studies [ 7 , 16 – 18 , 30 , 31 , 33 – 40 ] shows an overall compliance of 83 % (95 % CI 80–86 %); I 2 = 99.9 %, Z = 54.35, p < 0.001. Appropriate malaria treatment based on RDT results (Table 2 ) was as low as 39.7 % in a Zambian study [ 38 ] to as high as 99.9 % in Zanzibar [ 18 ].…”

Laboratory Diagnosis of Malaria: Conventional and Rapid Diagnostic Methods

“…11 The results of this study were similar for both children and adults. Although some other studies have come to the opposite conclusion, namely that use of MRDTs does result in use of antimalarial drugs more often in those patients with a positive test result, 12 most published observations are in keeping with the most recent WHO recommendations for using MRDTs (see below).…”

Prescription practices for malaria in Mozambique: poor adherence to the national protocols for malaria treatment in 22 public health facilities

“…It’s well documented that comprehensive training, periodic refresher courses and regular supervision visits leads to improvement of clinicians’ adherence to the new guidelines for malaria management. In fact, recent studies conducted in Tanzania demonstrated that adherence to new malaria guidelines was enhanced by comprehensive training, education and supervision [ 9 , 37 ]. Another study conducted in Ghana found similar results [ 38 ].…”