Journal Article

Malaria Rapid Testing by Community Health Workers Is Effective and Safe for Targeting Malaria Treatment: Randomised Cross-Over Trial in Tanzania

Mårtensson, Andreas, Warsame, Marian, Källander, Karin, Mubi, Marycelina, Petzold, Max G., Tomson, Göran, Ngasala, Billy, Massele, Amos, Maganga, Gloria, Janson, Annika, Björkman, Anders, Premji, Zul, Gustafsson, Lars L.

2011

Overview

Early diagnosis and prompt, effective treatment of uncomplicated malaria is critical to prevent severe disease, death and malaria transmission. We assessed the impact of rapid malaria diagnostic tests (RDTs) by community health workers (CHWs) on provision of artemisinin-based combination therapy (ACT) and health outcome in fever patients. Twenty-two CHWs from five villages in Kibaha District, a high-malaria transmission area in Coast Region, Tanzania, were trained to manage uncomplicated malaria using RDT aided diagnosis or clinical diagnosis (CD) only. Each CHW was randomly assigned to use either RDT or CD the first week and thereafter alternating weekly. Primary outcome was provision of ACT and main secondary outcomes were referral rates and health status by days 3 and 7. The CHWs enrolled 2930 fever patients during five months of whom 1988 (67.8%) presented within 24 hours of fever onset. ACT was provided to 775 of 1457 (53.2%) patients during RDT weeks and to 1422 of 1473 (96.5%) patients during CD weeks (Odds Ratio (OR) 0.039, 95% CI 0.029-0.053). The CHWs adhered to the RDT results in 1411 of 1457 (96.8%, 95% CI 95.8-97.6) patients. More patients were referred on inclusion day during RDT weeks (10.0%) compared to CD weeks (1.6%). Referral during days 1-7 and perceived non-recovery on days 3 and 7 were also more common after RDT aided diagnosis. However, no fatal or severe malaria occurred among 682 patients in the RDT group who were not treated with ACT, supporting the safety of withholding ACT to RDT negative patients. RDTs in the hands of CHWs may safely improve early and well-targeted ACT treatment in malaria patients at community level in Africa. ClinicalTrials.gov NCT00301015.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Accuracy / Adolescent / Adult / Aged / Antigens / Antimalarials - therapeutic use / Artemisinin / Artemisinins - therapeutic use / Child / Child, Preschool / Clinical trials / Clinics / Coastal zone / Community Health Services - standards / Community Health Services - statistics & numerical data / Community Health Workers - standards / Community Health Workers - statistics & numerical data / Community relations / Cross-Over Studies / Diagnosis / Diagnostic systems / Diagnostic tests / Diagnostic Tests, Routine - methods / Diagnostic Tests, Routine - standards / Disease transmission / Drug therapy / Drug Therapy, Combination / Female / Fever / Fever - drug therapy / Fever - etiology / Global health / Health aspects / Health facilities / Health Personnel - standards / Health Personnel - statistics & numerical data / Health sciences / Health services / Hospitals / Humans / Infectious diseases / Laboratories / Malaria / Malaria - complications / Malaria - diagnosis / Malaria - drug therapy / Male / Medical diagnosis / Medical personnel / Medical research / Medicine / Microscopy / Middle Aged / Outcome Assessment (Health Care) / Parasitology / Patients / Plasmodium falciparum / Prevention / Public health / Quality control / Studies / Tanzania / Vector-borne diseases / Workers