WHO Test and Treat Vs Presumptive treatment for malaria

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Are there any implications? There is likely to be an increased use of RDT in improving clinical decision making and treatment in malarious settings. While this can be justifiably correct in an era where malaria transmission is reducing, this reduction in transmission is not uniform, and therefore presumptive treatment based on sound clinical judgment can still be of some benefit in high transmission areas. Generally, in rural Africa, clinical care is often critically compromised by the lack of regulatory controls on the quality of diagnostics. Physicians can also be faced with having to select tests based only on information provided in the product insert or on published data that often originate from inadequate or flawed study designs. Furthermore, robust algorithms for negative RDTs rarely exist, thus adherence to diagnosis results is likely to be compromised. It will be important therefore, to consider local realities to decide how to treat fever patients with different parasitological outcome and to base selection of RDTs to be used in appropriate settings from sound scientific evidence. Secondly, presumptive treatment of malaria in an era of artemisinin based combination therapy should continue in resource limited settings. This will mean that the use of antibiotics is encouraged in such settings for malaria, despite the unavailability of diagnostic facility for other infections (bacterial or viral). Whether this is justified or not depends on local factors and physician judgment usually coloured by previous dramatic clinical experience and belief in point-of-care diagnostics. What effects would the one-size-fits-all recent WHO guidelines have on health care provider behaviour? what is likely to change? Is this change in support of the malaria elimination agenda? Many questions need to be investigated.