Article

Rapid diagnostic tests for the home-based management of malaria, in a high-transmission area.

Antenna Technologies, Rue de Neuchâtel 29, 1201 Geneva, Switzerland.
Annals of Tropical Medicine and Parasitology (impact factor: 1.43). 02/2009; 103(1):3-16. DOI:10.1179/136485909X384983 pp.3-16
Source: PubMed

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.

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Keywords

'test-and-treat' strategy
 
0-5 years
 
95% confidence interval
 
artemisinin-combination therapy
 
clinical malaria
 
commercial RDT
 
general practitioner's diagnosis
 
high-transmission area
 
home-based management
 
malarial parasites
 
negative predictive values
 
presumptive case
 
presumptive treatment
 
Rapid diagnostic tests
 
southern Mali
 
sub-Saharan Africa
 
two strategies
 
uncomplicated malaria
 
village healthworker
 
World Health Organization's