Influence of Rapid Malaria Diagnostic Tests on Treatment and Health Outcome in Fever Patients, Zanzibar—A Crossover Validation Study

Msellem, Mwinyi; Mårtensson, Andreas; Rotllant, Guida; Bhattarai, Achuyt; Strömberg, Johan; Kahigwa, Elizeus; García, Montse; Petzold, Max; Olumese, P.E.; Ali, Abdullah; Björkman, Anders

doi:10.1371/journal.pmed.1000070

Cited by 172 publications

(186 citation statements)

References 24 publications

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“…Even when tests are carried out, findings are accumulating from studies in different countries that show between 35 and 85% of RDT negative patients have been prescribed antimalarials Bisoffi et al, 2009;Chinkhumba et al, 2010;Elmardi et al, 2009;Hamer et al, 2007;Kyabayinze et al, 2010;Reyburn et al, 2007;Skarbinski et al, 2009). By contrast, other studies have found a reduction in overdiagnosis, down to between 4% and 16% RDT negative patients receiving antimalarials after the introduction of RDTs with various supporting interventions (Bastiaens et al, 2011;D'Acremont et al, 2009;Hopkins, 2008;Masanja et al, 2010;Mawili-Mboumba et al, 2009;Msellem et al, 2009;Thiam et al, 2011;Williams et al, 2008). In spite of this mixed evidence over the effect of introducing RDTs, and in the absence of good information about the best way to support their introduction for effective adoption, scale-up of the tests is being promoted (World Health Organisation, 2010), and many countries including Cameroon have included the tests in their Global Fund grant applications (Ministry of Public Health, 2009).…”

Section: Introductionmentioning

confidence: 93%

‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests

Chandler

Mangham

Abanda

et al. 2012

Social Science & Medicine

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Section: Introductionmentioning

confidence: 93%

‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests

Chandler

Mangham

Abanda

et al. 2012

Social Science & Medicine

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“…When good-quality malaria laboratory diagnosis is available and assuming test results are followed, prescribing of antimalarials to patients with nonmalaria fever can be minimized. 12,[31][32][33] Although resources are currently unavailable to fully equip health centers with a wide array of laboratory tests, periodic systematic evaluation of prevalent non-malarial febrile diseases could be conducted to determine the most critical laboratory tests and suggest what anti-infective agents should be recommended for treatment. Such streamlining would represent a more efficient use of limited resources and could be a portal for integrated clinical and laboratory services for multiple diseases.…”

Section: Integrated Fever Managementmentioning

confidence: 99%

Factoring Quality Laboratory Diagnosis into the Malaria Control Agenda for Sub-Saharan Africa

Aidoo

2013

The American Society of Tropical Medicine and Hygiene

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Abstract. Recent progress in malaria control in sub-Saharan Africa has been achieved primarily through provision of insecticide-treated nets, indoor residual spraying, and antimalarial drugs. Although these interventions are important, proper case identification and accurate measurement of their impact depend on quality diagnostic testing. Current availability of diagnostic testing for malaria in sub-Saharan Africa is inadequate to support disease management, prevention programs, and surveillance needs. Challenges faced include a dearth of skilled workforce, inadequate health systems infrastructure, and lack of political will. A coordinated approach to providing pre-service clinical and laboratory training together with systems that support a scale-up of laboratory services could provide means not only for effective malaria case management but also, management of non-malaria febrile illnesses, disease surveillance, and accurate control program evaluation. A synthesis of the challenges faced in ensuring quality malaria testing and how to include this information in the malaria control and elimination agenda are presented.

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“…Some studies show that use of RDTs increases antibiotic prescribing in malaria-negative patients [20,21] (Table 2). If the disease is a common cold, antibiotics should generally be avoided.…”

Section: Review Of the Evidence For The Assumptions Underlying Who's mentioning

confidence: 99%

"Test and treat" or presumptive treatment for malaria in high transmission situations? A reflection on the latest WHO guidelines

Graz

Willcox

Szeless

et al. 2011

Malar J

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Recent WHO guidelines recommend a universal "test and treat" strategy for malaria, mainly by use of rapid diagnostic test (RDT) in all areas. The evidence for this approach is questioned here as there is a risk of over-reliance on parasitological diagnosis in high transmission situations, which still exist. In such areas, when a patient has fever or other malaria symptoms, the presence of Plasmodium spp neither reliably confirms malaria as the cause of the fever, nor excludes the possibility of other diseases. This is because the patient may be an asymptomatic carrier of malaria parasites and suffer from another disease.To allow clinicians to perform their work adequately, local epidemiologic data are necessary. One size does not fit all. If parasite prevalence in the population is low, a diagnostic test is relevant; if the prevalence is high, the test does not provide information of any clinical usefulness, as happens with any test in medicine when the prevalence of the tested characteristic is high in the healthy population. It should also be remembered that, if in some cases anti-malarials are prescribed to parasite-negative patients, this will not increase selection pressure for drug resistance, because the parasite is not there.In high transmission situations at least, other diagnoses should be sought in all patients, irrespective of the presence of malaria parasites. For this, clinical skills (but not necessarily physicians) are irreplaceable, in order to differentiate malaria from other causes of acute fever, such as benign viral infection or potentially dangerous conditions, which can all be present with the parasite co-existing only as a "commensal" or silent undesirable guest.

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Influence of Rapid Malaria Diagnostic Tests on Treatment and Health Outcome in Fever Patients, Zanzibar—A Crossover Validation Study

Abstract: Anders Bjorkman and colleagues report results from a cross-over trial evaluating rapid diagnostic testing for malaria diagnosis in Zanzibar.

Cited by 172 publications

References 24 publications

‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests

‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests

Factoring Quality Laboratory Diagnosis into the Malaria Control Agenda for Sub-Saharan Africa

"Test and treat" or presumptive treatment for malaria in high transmission situations? A reflection on the latest WHO guidelines

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