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

Abstract

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.

Towards eliminating malaria in high endemic countries: the roles of community health workers and related cadres and their challenges in integrated community case management for malaria: a systematic review

“…Authority does not allow personnel with short-term training to prescribeStock out of supplies especially anti-malarialsPoor supervision especially in the hard to reach areasFunding instability. The programme is donor funded and subjected to delays in funding disbursementLack of community involvement and ownershipNo evidence yet on impact and no evaluation strategyAPEs are not paid3.Yansaneh et al [33]CHVsCHVs are not remunerated and have to do other income generating activitiesNot available when needed as they are not paid for their service4.Nanyonjo et al [30]CHWsPatients may not complete referrals5.Heidkamp et al [26]CHWsStock-out of essential suppliesPoor supervision from higher cadres6.Druetz et al [35]CHWsCommunity preference on qualified health workersCHWs not known to peopleMedicine stock-outLong distance to CHWs7.Banek et al [13]CMDsPatients overloadLack of supervisionLimited malaria knowledgeTensions with community membersLack of remuneration from the government8.Hamainza et al [22]CHWsLack of remunerationNegative attitudes to care given by CHWsWeak social responsibilities9.Abbey et al [24]CHWsHigh attrition rate of CHWs especially in hard-to-reach areas10.Tine et al [14]CHWsMedicine and RDT stock-out11.Ndiaye et al [39]CHWsMedicine and supply RDT stock-out (ACT, RDT, gloves, case files, patients forms)12.Blanas et al [28]CHWsACT and other supplies stock-outsExpired medicines or unavailable in villagesScepticism from villagesTransport problems, poor infrastructure and long distances for referrals13.Counihan et al [25]CHWsRDT and other medical supply stock-outs after ini...…”

“…For example, in Malawi, abbreviated CHW training did not meet medical regulation standards for prescription resulting in CHWs not being allowed to prescribe anti-malarials [20]. Lack of supervision from qualified health workers and poor coordination from the existing health infrastructure affected implementation of CHWs’ role in iCCM [20, 21, 25, 26]. …”

Rational use of antibiotics by community health workers and caregivers for children with suspected pneumonia in Zambia: a cross-sectional mixed methods study

“…Although the low utilisation of these tools may be due to the presence of the observer [16], these data could suggest that the CHWs are confident in their ability to recall the diagnostic algorithm and danger signs, given the high level of adherence to the guidelines.…”

Clinical outcomes among febrile children aged 2 to 59 months with negative malaria rapid diagnostic test results in Mchinji District, Malawi

“…1 As a result, mRDTs are now being integrated into community case management programmes [2][3][4] to mitigate against parasite resistance to antimalarial drugs and reduce waste associated with presumptive treatment. 5 However, although mRDTs are highly sensitive, 6 health workers still treat for malaria even after negative mRDT test results.…”