The impact of introducing malaria rapid diagnostic tests on fever case management: a synthesis of ten studies from the ACT consortium

Academic Article

Abstract

  • Since 2010, theWorld Health Organization has been recommending that all suspected cases of malaria be confirmed with parasite-based diagnosis before treatment. These guidelines represent a paradigm shift away from presumptive antimalarial treatment of fever. Malaria rapid diagnostic tests (mRDTs) are central to implementing this policy, intended to target artemisinin-based combination therapies (ACT) to patients with confirmed malaria and to improvemanagement of patientswith nonmalarial fevers. The ACT Consortiumconducted ten linked studies, eight in sub-Saharan Africa and two in Afghanistan, to evaluate the impact of mRDT introduction on case management across settings that vary in malaria endemicity and healthcare provider type. This synthesis includes 562,368 outpatient encounters (study size range 2,400-432,513). mRDTs were associated with significantly lower ACT prescription (range 8-69% versus 20-100%). Prescribing did not always adhere to malaria test results; in several settings, ACTs were prescribed to more than 30% of test-negative patients or to fewer than 80% of test-positive patients. Either an antimalarial or an antibiotic was prescribed for more than 75% of patients across most settings; lower antimalarial prescription for malaria test-negative patients was partly offset by higher antibiotic prescription. Symptomatic management with antipyretics alone was prescribed for fewer than 25% of patients across all scenarios. In community health worker and private retailer settings, mRDTs increased referral of patients to other providers. This synthesis provides an overviewof shifts in casemanagement thatmay be expected withmRDT introduction and highlights areas of focus to improve design and implementation of future case management programs.
  • Authors

    Digital Object Identifier (doi)

    Author List

  • Bruxvoort KJ; Leurent B; Chandler CIR; Ansah EK; Baiden F; Bjorkman A; Burchett HED; Clarke SE; Cundill B; DiLiberto DD
  • Start Page

  • 1170
  • End Page

  • 1179
  • Volume

  • 97
  • Issue

  • 4