The effect of malaria rapid diagnostic tests results on antimicrobial prescription practices of health care workers in Burkina Faso

Abstract

BackgroundMalaria rapid diagnostic tests (RDT) are widely used in endemic areas in order to comply with the recommendation that malaria treatment should only be given after the clinical diagnosis has been confirmed by RDT or microscopy. However, the overestimation of malaria infection with the use of PfHRP2 based RDT, makes the management of febrile illnesses more challenging. This study aimed to assess the effect of the use of malaria RDT on antimicrobial prescription practices.MethodsA prospective study was conducted among febrile children under-5 years of age attending four health facilities and the referral hospital in the Nanoro Health District (Burkina Faso). To assess the effect of malaria RDT testing on the prescriptions of antimicrobials in febrile children, the initial diagnosis and antimicrobial prescriptions following a malaria RDT testing were recorded. The necessity of these prescriptions was subsequently checked by assessing the actual cause of fever by expert malaria microscopy and a microbiology analysis of blood, urine, stool and nasopharynx swabs that were collected from febrile cases to determine the actual cause of the fever episode.ResultsMalaria was diagnosed by nurses, who are the primary health care providers, with a malaria RDT in 72.7% (798/1098) of febrile children, but only 53.7% (589/1097) cases could be confirmed by expert microscopy. Health care workers were likely to prescribe antimalarials to malaria positive RDT compared to malaria negative RDT (RR = 7.74, p = 0.00001). Malaria negative RDT result had a significant influence on the antibiotic prescriptions (RR = 3.57, p = 0.0001). The risk of prescribing antimicrobials was higher in health facility level compared to referral hospital. By cross-checking of laboratory findings to antimicrobial prescriptions, an important part of children with positive bacterial infection have received antibiotic prescriptions although the majority without any infection have also received antibiotics.ConclusionDespite the good attitude of health care workers to adhere to diagnostic test results, antimalarials and antibiotics remain inappropriate prescribed to febrile children. The low specificity of malaria RDT used could be an important cause of these practices.

Contribution of P. falciparum parasites with Pfhrp 2 gene deletions to false negative PfHRP 2 based malaria RDT results in Ghana: A nationwide study of symptomatic malaria patients

“…Deletions in the Pfhrp 2 gene that result in false negative malaria RDT results are detrimental and have the potential of missing malaria positive patients in countries like Ghana where testing is largely by PfHRP2 RDTs. The symptomatic malaria patients who test negative may likely not receive appropriate antimalarial treatment [13,14]. To ensure the maintenance of the diagnostic accuracy of malaria RDT results and prevent the misdiagnosis of malaria in the era of the WHO's Test Treat and Track initiative, the WHO partnered with the Foundation for Innovative New Diagnostics (FIND) to set up the WHO-FIND Malaria Evaluation Programme to provide quality assurance for the manufacture of malaria RDT kits [15].…”

Effect of Free Healthcare Policy for Children under Five Years Old on the Incidence of Reported Malaria Cases in Burkina Faso by Bayesian Modelling: “Not only the Ears but also the Head of the Hippopotamus”

“…Indeed, a study conducted in Burkina Faso evidenced a shift in health workers' attitudes when faced with negative RDT; they tended to prescribe antibiotics rather than ACT. The authors found that 92.89% of nurses were compliant with the rapid test result [63]. At a regional level, a multi-country study conducted in three West African countries, including Burkina Faso, showed an overall noncompliance rate below 1% in a small proportion (6.8%) of the community health workers (CHWs) involved.…”

Antimicrobial resistance at the human–animal interface in the Pastoralist Communities of Kasese District, South Western Uganda

“…Bacteria from animals are among the predominant causes of diseases in the food chain 2 . Even with the recognition of these facts, zoonotic infections frequently remain undiagnosed in humans and usually mistaken for other febrile diseases such as malaria among others 6 , 7 . The present success of animal husbandry has been linked to the use of antibiotics as growth promoters and in the prevention of infections but this may present a huge cost for the future.…”