Major Reduction in Anti-Malarial Drug Consumption in Senegal after Nation-Wide Introduction of Malaria Rapid Diagnostic Tests

Abstract

BackgroundWhile WHO recently recommended universal parasitological confirmation of suspected malaria prior to treatment, debate has continued as to whether wide-scale use of rapid diagnostic tests (RDTs) can achieve this goal. Adherence of health service personnel to RDT results has been poor in some settings, with little impact on anti-malarial drug consumption. The Senegal national malaria control programme introduced universal parasite-based diagnosis using malaria RDTs from late 2007 in all public health facilities. This paper assesses the impact of this programme on anti-malarial drug consumption and disease reporting.Methods and FindingsNationally-collated programme data from 2007 to 2009 including malaria diagnostic outcomes, prescription of artemisinin-based combination therapy (ACT) and consumption of RDTs in public health facilities, were reviewed and compared. Against a marked seasonal variation in all-cause out-patient visits, non-malarial fever and confirmed malaria, parasite-based diagnosis increased nationally from 3.9% of reported malaria-like febrile illness to 86.0% over a 3 year period. The prescription of ACT dropped throughout this period from 72.9% of malaria-like febrile illness to 31.5%, reaching close equivalence to confirmed malaria (29.9% of 584873 suspect fever cases). An estimated 516576 courses of inappropriate ACT prescription were averted.ConclusionsThe data indicate high adherence of anti-malarial prescribing practice to RDT results after an initial run-in period. The large reduction in ACT consumption enabled by the move from symptom-based to parasite-based diagnosis demonstrates that effective roll-out and use of malaria RDTs is achievable on a national scale through well planned and structured implementation. While more detailed information on management of parasite-negative cases is required at point of care level to assess overall cost-benefits to the health sector, considerable cost-savings were achieved in ACT procurement. Programmes need to be allowed flexibility in management of these funds to address increases in other programmatic costs that may accrue from improved diagnosis of febrile disease.

‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests

“…Even when tests are carried out, findings are accumulating from studies in different countries that show between 35 and 85% of RDT negative patients have been prescribed antimalarials Bisoffi et al, 2009;Chinkhumba et al, 2010;Elmardi et al, 2009;Hamer et al, 2007;Kyabayinze et al, 2010;Reyburn et al, 2007;Skarbinski et al, 2009). By contrast, other studies have found a reduction in overdiagnosis, down to between 4% and 16% RDT negative patients receiving antimalarials after the introduction of RDTs with various supporting interventions (Bastiaens et al, 2011;D'Acremont et al, 2009;Hopkins, 2008;Masanja et al, 2010;Mawili-Mboumba et al, 2009;Msellem et al, 2009;Thiam et al, 2011;Williams et al, 2008). In spite of this mixed evidence over the effect of introducing RDTs, and in the absence of good information about the best way to support their introduction for effective adoption, scale-up of the tests is being promoted (World Health Organisation, 2010), and many countries including Cameroon have included the tests in their Global Fund grant applications (Ministry of Public Health, 2009).…”

Infectiousness of the Human Population to Anopheles arabiensis by Direct Skin Feeding in an Area Hypoendemic for Malaria in Senegal

“…[1][2][3] In Senegal, malaria transmission has declined recently, 4 although Plasmodium falciparum remains endemic throughout the country. 5 Malaria transmission occurs from mosquito to man and from man to mosquito. Transmission from man to mosquitoes is poorly quantified 6 and a focus often lies on entomological parameters like aggressiveness of anophelines to humans, the entomological inoculation rate, vectorial capacity, 7,8 and indicators of parasite prevalence in the human population.…”

Development of artemether-loaded nanostructured lipid carrier (NLC) formulation for topical application

“…Resistance is occurring as a consequence of several factors, including poor treatment practices, inadequate patient adherence to prescribed antimalarial regimens, widespread availability of artemisininbased monotherapies and substandard forms of the drug [9,10]. In recent years, parasite resistance to artemisinins -the key compounds in artemisinin combination therapy (ACTs) -has been detected in four countries of the Greater Mekong subregion: Cambodia, Myanmar, Thailand and Vietnam in agreement with the prediction of the World Health Organization (WHO) 2010 [6].…”