Community Health Workers Use Malaria Rapid Diagnostic Tests (RDTs) Safely and Accurately: Results of a Longitudinal Study in Zambia

Malaria Consortium, Maputo, Mozambique; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Malaria Consortium, Lusaka, Zambia; Zambia National Malaria Control Center, Lusaka, Zambia; Livingstone District Health Management Team, Livingstone, Zambia; World Health Organization, Lusaka, Zambia; Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
The American journal of tropical medicine and hygiene (Impact Factor: 2.7). 07/2012; 87(1):57-63. DOI: 10.4269/ajtmh.2012.11-0800
Source: PubMed


Malaria rapid diagnostic tests (RDTs) could radically improve febrile illness management in remote and low-resource populations. However, reliance upon community health workers (CHWs) remains controversial because of concerns about blood safety and appropriate use of artemisinin combination therapy. This study assessed CHW ability to use RDTs safely and accurately up to 12 months post-training. We trained 65 Zambian CHWs, and then provided RDTs, job-aids, and other necessary supplies for village use. Observers assessed CHW performance at 3, 6, and 12 months post-training. Critical steps performed correctly increased from 87.5% at 3 months to 100% subsequently. However, a few CHWs incorrectly read faint positive or invalid results as negative. Although most indicators improved or remained stable over time, interpretation of faint positives fell to 76.7% correct at 12 months. We conclude that appropriately trained and supervised CHWs can use RDTs safely and accurately in community practice for up to 12 months post-training.

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Available from: Busiku Hamainza
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    • "It is not clear why these districts still have more than 90% clinically diagnosed cases after extended use of RDTs was rolled out in 2005-2006. A study has shown that appropriately trained and supervised CHWs can use RDTs, both safely and accurately, in community practice in Zambia (Counihan et al., 2012). "
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    ABSTRACT: Malaria is an important health burden in Zambia with proper diagnosis remaining as one of the biggest challenges. The need for reliable diagnostics is being addressed through the introduction of rapid diagnostic tests (RDTs). However, without sufficient laboratory amenities in many parts of the country, diagnosis often still relies on non-specific, clinical symptoms. In this study, geographical information systems were used to both visualize and analyze the spatial distribution and the risk factors related to the diagnosis of malaria. The monthly reported, district-level number of malaria cases from January 2009 to December 2014 were collected from the National Malaria Control Center (NMCC). Spatial statistics were used to reveal cluster tendencies that were subsequently linked to possible risk factors, using a non-spatial regression model. Significant, spatio-temporal clusters of malaria were spotted while the introduction of RDTs made the number of clinically diagnosed malaria cases decrease by 33% from 2009 to 2014. The limited access to road network(s) was found to be associated with higher levels of malaria, which can be traced by the expansion of health promotion interventions by the NMCC, indicating enhanced diagnostic capability. The capacity of health facilities has been strengthened with the increased availability of proper diagnostic tools and through retraining of community health workers. To further enhance spatial decision support systems, a multifaceted approach is required to ensure mobilization and availability of human, infrastructural and technological resources. Surveillance based on standardized geospatial or other analytical methods should be used by program managers to design, target, monitor and assess the spatio-temporal dynamics of malaria diagnostic resources country-wide.
    Full-text · Article · May 2015 · Geospatial health
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    • "The assessment of each individual executed step in this study showed that problems were found in dispensing buffer drops, waiting correct amount of time, pricking side of finger, blood collection and recording result in register. Counihan et al. [18], who assessed only the execution of eight RDT steps (see Additional file 4) that were considered critical for diagnosis or safety, showed improvement over time: 40.3, 61.7 and 79.7% of CHWs correctly performed critical steps at three, six and 12 months, respectively. Problematic steps were writing patient’s name on cassette, recording results in register, usage of the blood collection loop, reading the test result in the right time and disposing non-sharps in non-sharps container [18-20]. "
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    ABSTRACT: Malaria still causes high morbidity and mortality around the world, mainly in sub-Saharan Africa. Community case management of malaria (CCMm) by community health workers (CHWs) is one of the strategies to combat the disease by increasing access to malaria treatment. Currently, the World Health Organization recommends to treat only confirmed malaria cases, rather than to give presumptive treatment.Objectives: This systematic review aims to provide a comprehensive overview of the success or failure of critical steps in CCMm with rapid diagnostic tests (RDTs).
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    • "The concept of community-based management of malaria stems from the recognition that human resource deficits amongst clinically-trained professional cadres are commonplace, so extending service delivery beyond centralized health facilities, by mobilizing through community health workers (CHW) will be required to improve access to appropriate management of uncomplicated malaria [43,44]. CHWs have demonstrated the capacity to effectively diagnose malaria with RDTs and provide treatment according to the locally relevant policy and guidelines [41,42,45,46]. The community-based diagnosis and treatment approach has also been shown to be cost-effective [47,48], improve delivery of malaria case management overall [49-51], is well accepted by communities [52-54] and also provides a potentially valuable population–wide platform for monitoring trends in human parasitaemia [55]. "
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