Rapid diagnostic tests for the home-based management of malaria, in a high-transmission area.
ABSTRACT Rapid diagnostic tests (RDT) are sometimes recommended to improve the home-based management of malaria. The accuracy of an RDT for the detection of clinical malaria and the presence of malarial parasites has recently been evaluated in a high-transmission area of southern Mali. During the same study, the cost-effectiveness of a 'test-and-treat' strategy for the home-based management of malaria (based on an artemisinin-combination therapy) was compared with that of a 'treat-all' strategy. Overall, 301 patients, of all ages, each of whom had been considered a presumptive case of uncomplicated malaria by a village healthworker, were checked with a commercial RDT (Paracheck-Pf). The sensitivity, specificity, and positive and negative predictive values of this test, compared with the results of microscopy and two different definitions of clinical malaria, were then determined. The RDT was found to be 82.9% sensitive (with a 95% confidence interval of 78.0%-87.1%) and 78.9% (63.9%-89.7%) specific compared with the detection of parasites by microscopy. In the detection of clinical malaria, it was 95.2% (91.3%-97.6%) sensitive and 57.4% (48.2%-66.2%) specific compared with a general practitioner's diagnosis of the disease, and 100.0% (94.5%-100.0%) sensitive but only 30.2% (24.8%-36.2%) specific when compared against the fulfillment of the World Health Organization's (2003) research criteria for uncomplicated malaria. Among children aged 0-5 years, the cost of the 'test-and-treat' strategy, per episode, was about twice that of the 'treat-all' (U.S.$1.0. v. U.S.$0.5). In older subjects, however, the two strategies were equally costly (approximately U.S.$2/episode). In conclusion, for children aged 0-5 years in a high-transmission area of sub-Saharan Africa, use of the RDT was not cost-effective compared with the presumptive treatment of malaria with an ACT. In older patients, use of the RDT did not reduce costs. The question remains whether either of the strategies investigated can be made affordable for the affected population.
Transactions of the Royal Society of Tropical Medicine and Hygiene 01/2012; 106:137-142. · 2.16 Impact Factor
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ABSTRACT: Home-based management of malaria is promoted as a major strategy for improving prompt delivery of effective malaria treatment in Africa. This study aimed to determine the proportion of children who tested positive for malaria with routine light microscopy among those whose mothers had made a home-based diagnosis in a rural community in Western Kenya. This cross-sectional study was conducted at Bokoli location, Bungoma East District in November and December 2007. Mothers of children five years of age or under with malaria diagnosed by their mothers were interviewed (n = 96). Duplicate blood smears were collected, stained by field stain A (Methylene blue, Azure) and B (Eosin), and examined for malaria parasites using light microscopy. Only 30/96 (31.2%) specimens were positive for Plasmodium falciparum. Elevated temperature (70/96; 72.9%) in their children was the most commonly cited criterion for diagnosis of malaria by the mothers. In 57 of the 96 cases, information was given by the mothers regarding treatment during the current malaria episode; of these, 10 (17.5%) had received treatment for malaria, but six (60%) of these were parasite negative. This means that only 4/21 (19.0%) with positive smear microscopy received treatment. The most common anti-malaria drugs used were Fansidar (37.8%) and Metakelfin (29.7%). Conclusion: The difficulty of diagnosing malaria accurately at home increases the urgent need for improved diagnostic tools that can be used at the community level in poor populations. Intervention measures are needed to increase the treatment rate to reduce reservoirs and malaria parasite transmission.The Journal of Infection in Developing Countries 01/2011; 5(1):54-8. · 1.19 Impact Factor
Article: Feasibility and acceptability of ACT for the community case management of malaria in urban settings in five African sites.[show abstract] [hide abstract]
ABSTRACT: The community case management of malaria (CCMm) is now an established route for distribution of artemisinin-based combination therapy (ACT) in rural areas, but the feasibility and acceptability of the approach through community medicine distributors (CMD) in urban areas has not been explored. It is estimated that in 15 years time 50% of the African population will live in urban areas and transmission of the malaria parasite occurs in these densely populated areas. Pre- and post-implementation studies were conducted in five African cities: Ghana, Burkina Faso, Ethiopia and Malawi. CMDs were trained to educate caregivers, diagnose and treat malaria cases in < 5-year olds with ACT. Household surveys, focus group discussions and in-depth interviews were used to evaluate impact. Qualitative findings: In all sites, interviews revealed that caregivers' knowledge of malaria signs and symptoms improved after the intervention. Preference for CMDs as preferred providers for malaria increased in all sites.Quantitative findings: 9001 children with an episode of fever were treated by 199 CMDs in the five study sites. Results from the CHWs registers show that of these, 6974 were treated with an ACT and 6933 (99%) were prescribed the correct dose for their age. Fifty-four percent of the 3,025 children for which information about the promptness of treatment was available were treated within 24 hours from the onset of symptoms.From the household survey 3700 children were identified who had an episode of fever during the preceding two weeks. 1480 (40%) of them sought treatment from a CMD and 1213 of them (82%) had received an ACT. Of these, 1123 (92.6%) were administered the ACT for the correct number of doses and days; 773 of the 1118 (69.1%) children for which information about the promptness of treatment was available were treated within 24 hours from onset of symptoms, and 768 (68.7%) were treated promptly and correctly. The concept of CCMm in an urban environment was positive, and caregivers were generally satisfied with the services. Quality of services delivered by CMDs and adherence by caregivers are similar to those seen in rural CCMm settings. The proportion of cases seen by CMDs, however, tended to be lower than was generally seen in rural CCMm. Urban CCMm is feasible, but it struggles against other sources of established healthcare providers. Innovation is required by everyone to make it viable.Malaria Journal 08/2011; 10:240. · 3.19 Impact Factor