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Scientific title: Effects of Restricting the Use of Artesunate Plus Amodiaquine Combination Therapy to Malaria Cases Confirmed by a Dipstick Test: A Cluster Randomised Control Trial (RDT-ACT)
What did we know before this research?
In sub-Saharan Africa it is common to overdiagnose and overtreat malaria, which means that patients who are not formally diagnosed with malaria are still considered to have the disease and therefore receive anti-malarial treatment. This leads to the waste of expensive drugs and increases the risk of developing drug resistance.
The over-diagnosis of malaria happens mainly due to the lack of diagnostic tools that could be readily used at point of care. Also, overprescribing antimalarials was thought to have the beneficial effect of protecting even children who did not have malaria.
The availability of rapid diagnostic tests (RDT) for malaria restricts the prescription of antimalarials to children who are confirmed to have malaria through an RDT. This could reduce the number of children who are prescribed antimalarial and possibly put more children at increased risk of malaria as they will not benefit from its preventive effect (known as prophylaxis).
What does this study add?
In this study we have tested the effects of providing ACT drugs only to patients who did a rapid diagnostic test and whose result was positive. This approach could improve the treatment of malaria, as well as support health services to better manage non-malaria illnesses that also cause fever. One example is pneumonia, which is often misdiagnosed as malaria in children. Finally, this system could also reduce the use of anti-malarials and consequently the risk of developing drug resistance.
We have assessed the accuracy of rapid diagnostic tests and the outcomes of treatment based on RDT results in 32 health facilities. The team conducted interviews with health providers to understand their diagnostic and treatment decisions, as well as exit interviews with carers of children under five years old presenting fever to assess their satisfaction with the treatment received.
The research team
Prof. Daniel Chandramohan, London School of Hygiene & Tropical Medicine
Dr. Seth Owusu-Agyei, Kintampo Health Research Centre, Kintampo
Ms. Jayne Webster, London School of Hygiene and Tropical Medicine
Dr. Frank Baiden, Kintampo Health Research Centre, Kintampo
Ms. Jane Bruce, London School of Hygiene and Tropical Medicine
Latest on this research
This study has made it possible for us to know with greater certainty the effect of restricting antimalarial to only children confirmed to have malaria. This includes how frequently they will get malaria or anaemia, and how this will impact on the prescriptions of other drugs.
Various sub-aspects of the study have been presented to national stakeholders, peresented at international conferences and published in various journals. We are currently preparing the final publications.
This forum does not give much information on the conduction of the study and if the results are already published.
Rapid diagnostic tests are getting much appreciation even at the community level with its shorter duration of the test.
One thing that i had observed at the community is the economic status of the population as some people prefer to buy the ACT on symptoms rather than testing first.The test cost TSHS 1500 and adult dose of Alu costs 3000.Government subsidies are heavily required on this area.