Malaria rapid diagnostic test transport and storage conditions in Burkina Faso, Senegal, Ethiopia and the Philippines

Abstract

BackgroundAs more point of care diagnostics become available, the need to transport and store perishable medical commodities to remote locations increases. As with other diagnostics, malaria rapid diagnostic tests (RDTs) must be highly reliable at point of use, but exposure to adverse environmental conditions during distribution has the potential to degrade tests and accuracy. In remote locations, poor quality diagnostics and drugs may have significant negative health impact that is not readily detectable by routine monitoring. This study assessed temperature and humidity throughout supply chains used to transport and store health commodities, such as RDTs.MethodsMonitoring devices capable of recording temperature and humidity were deployed to Burkina Faso (8), Senegal (10), Ethiopia (13) and the Philippines (6) over a 13-month period. The devices travelled through government supply chains, usually alongside RDTs, to health facilities where RDTs are stored, distributed and used. The recording period spanned just over a year, in order to avoid any biases related to seasonal temperature variations.ResultsIn the four countries, storage and transport temperatures regularly exceeded 30.0°C; maximum humidity level recorded was above 94% for the four countries. In three of the four countries, temperatures recorded at central storage facilities exceeded pharmaceutical storage standards for over 20% of the time, in another case for a majority of the time; and sometimes exceeded storage temperatures at peripheral sites.ConclusionsMalaria RDTs were regularly exposed to temperatures above recommended limits for many commercially-available RDTs and other medical commodities such as drugs, but rarely exceeded the recommended storage limits for particular products in use in these countries. The results underline the need to select RDTs, and other commodities, according to expected field conditions, actively manage the environmental conditions in supply chains in tropical and sub-tropical climates. This would benefit from a re-visit of current global standards on stability of medical commodities based in tropical and sub-tropical climatic zones.

Implementation of a malaria rapid diagnostic test in a rural setting of Nanoro, Burkina Faso: from expectation to reality

“…The participating health facilities in this study had no air-conditioning system or temperature and humidity monitoring system in their store room. This can severely affect the test performance as previously reported [8, 39, 40]. Moreover, periodical quality checks of the RDT at the health facilities are not in place.…”

Field assessment of dried Plasmodium falciparum samples for malaria rapid diagnostic test quality control and proficiency testing in Ethiopia

“…The RDTs distributed in many malaria-endemic countries may be exposed to higher temperatures than recommended by manufacturers [ 18 ]; in Ethiopia, the maintenance of a logistical supply chain with relatively cool ambient conditions may be especially difficult since items might be stored for days or weeks within shipping containers, and many items are imported through the port of Djibouti where very high temperatures are prevalent. A major challenge to widespread RDT use in the field is the ability to monitor their continued performance after exposure to the high temperature conditions typical of many malaria-endemic countries.…”

Paracheck® rapid diagnostic test for detecting malaria infection in under five children: a population-based survey in Burkina Faso

“…In Burkina Faso, the performance of RDT has been largely documented in clinical settings [ 12 - 19 ], but no study has been undertaken nationwide at community level. A recent Demography and Health Survey (DHS) included for the first time the use of RDT to detect malaria infection in children under five years of age.…”