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Scientific title: The role and cost-effectiveness of rapid diagnostic tests in home-based management of malaria using artemether-lumefantrine: a comparative study in two areas of high and low malaria transmission in rural Uganda

Malaria management by community health workers from ACT Consortium on Vimeo.

What did we know before this research?

Most malaria deaths occur within 48 hours after the first symptoms appear. In rural areas, where access to health centres is poor, home-based management of malaria can reduce mortality caused by the disease by up to 50%. This approach provides training to selected members of the community to recognise the signs and symptoms of malaria in a child, and then to be able to give effective treatment near the patients’ home. This approach increases access to treatment, and ensures that children receive malaria treatment as quickly as possible.

In order to maximise the coverage and impact of artemisinin-based combination therapies (ACT), these drugs should be available not only in health centres but also in programmes of home-based management of malaria.

What does this study add?

Currently there is a significant over-use of antimalarial drugs. This happens because many cases of fever are immediately treated as malaria even without a blood test or laboratory confirmation. Since ACT drugs are generally more expensive than regular drugs, it is important that their use is restricted to people who are formally diagnosed with a blood test. This can be done by using rapid diagnostic tests (RDT), which don’t require electricity or qualified health staff.

This study evaluates whether the use of rapid diagnostic tests by community medicine distributors – with the aim to improve diagnosis and treatment of malaria in the community – is feasible, well accepted and cost-effective.

This cluster randomized trial compares two approaches. On the one hand, the new approach of using rapid diagnostic tests to diagnose malaria and, on the other hand, the current practice of treating patients with malaria drugs based solely on signs and symptoms (known as presumptive diagnosis).

This comparison aims to evaluate whether the use of rapid diagnostic tests in the management of fever within the community can improve the targeting of malaria treatment to those that need it most. The study also examines the impact of diagnostic testing on patients that do not have malaria, and whether a negative test result reduces unnecessary use of ACT medication and/or increases the likelihood of being referred to a qualified health care provider for more expert diagnosis. The evaluation is being carried out in areas of both low and high malaria transmission.

Principal Investigators

Dr Richard Ndyomugyenyi, National Malaria Control Programme, Ministry of Health, Kampala, Uganda

Dr. Siân Clarke, London School of Hygiene & Tropical Medicine, UK

Other Investigators

Dr Pascal Magnussen, DBL Institute for Health Research and Development, Faculty of Life Sciences, Copenhagen University, Frederiksberg, Denmark.
Dr Kristian Schultz Hansen, London School of Hygiene and Tropical Medicine, Keppel St, London

Latest news:
The project is now reaching completion.

Early analysis suggests that many community medicine distributors complied with the results of rapid diagnostic tests. The community were also aware that not all fever is caused by malaria, which increased the acceptability of the tests. As a result, the number of ACT treatments given reduced dramatically.