Malaria: Diagnostics: Methods and Impact
Community level management of fever in Afghanistan - the role of malaria rapid diagnostic tests.
11/12/2012 5:00:00 PM
, Amy Mikhail
, Ismail Mayan
, Asif Alokozai
, Nader Mohammed
, Anwar Hasanzai
, Habib Bakhtash
, Bonnie Cundill
, Christopher J. Whitty
, Mark Rowland
London School of Hygiene and Tropical Medicine, London, United Kingdom,
Health Protection and Research Organisation, Kabul, Afghanistan,
HealthNet TPO, Jalalabad, Afghanistan,
MERLIN, Kunduz, Afghanistan
In areas of low and seasonal malaria transmission, differential diagnosis of non-specific fever is important for patient care, control of malaria and in treatment and control of non-malarial causes of fever. Afghanistan is endemic for both vivax and falciparum malaria but with a low transmission intensity and dominated by vivax which accounts for 80-90% of cases. Our previous research has shown that malaria is consistently over-diagnosed and treated at the clinic level, but little is known about how community health workers (CHW) treat patients in the community. A cluster randomised trial of malaria rapid diagnostic tests (RDT) was undertaken using 400 CHWs to recruit 2600 patients in two transmission areas of Afghanistan. All CHWs administratively attached to 22 clinics (clusters) received training on management of malaria according to Government and WHO guidelines. Half of the clinics were randomly assigned to the intervention (RDTs), while half used clinical signs and symptoms for diagnosis and treatment. The primary outcome was the proportion of patients appropriately treated and aimed to evaluate whether the intervention resulted in improved targeting of treatment for patients with and without malaria. This included the use of artemisinin combination therapy for the rarely encountered cases of falciparum malaria. The outcome was measured against PCR based diagnosis of malaria to give a gold-standard diagnosis. The accuracy of the RDT and the prescribers’ response to the results was assessed. This presentation will outline the results of the study and discuss implications for policy and practice of fever treatment at community and clinic level in malaria endemic areas outside Africa.
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