Shifting from Presumptive to Test-Based Management of Malaria - Technical Basis and Implications for Malaria Control in Ghana

Baiden, Frank; Malm, Keziah; Bart-Plange, Constance; Hodgson, Abraham; Chandramohan, Daniel; Webster, Jayne; Owusu‐Agyei, Seth

doi:10.4314/gmj.v48i2.10

Cited by 21 publications

(30 citation statements)

References 81 publications

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Section: /8 Oalib Journalmentioning

confidence: 78%

“…There are documented evidences that most health workers disregard negative malaria microscopy and prescribe anti-malarial treatment [9]. This same disregard has also been noticed with RDT [9]. The aim of this study was to assess the prevalence of malaria positive RDT and antimalarial treatment among patients with febrile illness seeking care in the accident and emergency unit of the Effia Nkwanta Regional Hospital, Ghana.…”

Section: /8 Oalib Journalmentioning

confidence: 86%

“…This was necessary at that time as there was very high burden of malaria among children and prompt treatment was necessary to prevent severe and fatal outcomes [8]. This protocol has long been replaced with a more evidence-based approach that solely depends on parasitological confirmation of malaria before treatment [6] [9].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Malaria Positive Rapid Diagnostic Test and Antimalarial Treatment in Patients with Fevers in the Accident and Emergency Unit of Effia Nkwanta Regional Hospital, Western Region, Ghana

Orish¹,

Ofori-Amoah²,

Afeke³

et al. 2016

OALib

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Background: Rapid diagnostic test (RDT) is a simpler, easy to read malaria diagnostic test. It was introduced by the World Health Organization (WHO) to supplement the use of microscopy and can be used alone in areas where microscopy is unavailable. Its introduction was necessary to maintain the WHO test-based treatment protocol for malaria, as dependence of microscopy which is the gold standard is not possible in many areas in Sub-Saharan Africa which lack the wherewithal to run efficient laboratory services. WHO strongly recommends that only patients with parasitological confirmation of malaria should be treated with antimalarial drugs. In this study, the prevalence of malaria positive RDT and antimalarial treatment was evaluated in patients presenting with fevers at the outpatient section of the accident and emergency unit of the Effia Nkwanta Regional Hospital, Ghana. Methodology: This was a retrospective study carried out in the outpatient section of the accident emergency unit of Effia Nkwanta Regional Hospital. The outpatient register was reviewed from October 2014 to March 2015, for patients who came with fever. Data on demographics, malaria RDT status and antimalarial treatment were collected and analyzed. Result: A total of 607 patients with fever had their RDT performed. Of these, 131 (21.58%) were positive for malaria while 467 (78.42%) were negative. Out of the 131 tested positive, 55 represented patients above 12 years and 76 represent children

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Section: /8 Oalib Journalmentioning

confidence: 78%

Section: /8 Oalib Journalmentioning

confidence: 86%

See 1 more Smart Citation

Prevalence of Malaria Positive Rapid Diagnostic Test and Antimalarial Treatment in Patients with Fevers in the Accident and Emergency Unit of Effia Nkwanta Regional Hospital, Western Region, Ghana

Orish¹,

Ofori-Amoah²,

Afeke³

et al. 2016

OALib

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“…Practically, this implies that in all suspected cases, the diagnosis of uncomplicated malaria should be confirmed using a parasitological test (either microscopy or RDT) prior to treatment [20, 21]. Arguments in favour of the shift to test-based management of malaria were of the opinion that the factors which justified presumptive approach were no longer valid namely: high malaria transmission; availability of affordable yet effective antimalarial drugs; and lack of appropriate diagnostic tools.…”

Section: Introductionmentioning

confidence: 99%

Cost benefit analysis of malaria rapid diagnostic test: the perspective of Nigerian community pharmacists

Ezennia

Nduka

Ekwunife

2017

Malar J

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Background In 2010, the World Health Organization issued a guideline that calls for a shift from presumptive to test-based treatment. However, test-based treatment is still unpopular in community pharmacies. This could be due to unwillingness of customers to spend extra finance on rapid diagnostic test (RDT). It could also result from lack of interest from community pharmacists since they may perceive no financial gain attached to this service. This study assessed the cost-benefit of test-based malaria treatment to community pharmacists. MethodsThe study was a community pharmacy-based cross sectional survey. Potential benefit of RDT was determined using customers’ willingness-to-pay (WTP) for service. Average WTP was estimated using contingent valuation. Binary logistic regression was used to assess correlates of WTP acceptance while multiple linear regression was used to model the relationship between the independent variables and WTP amount. Cost associated with provision of RDT was estimated from provider’s perspective. Probabilistic sensitivity analysis was used to capture parameter uncertainty. Benefit-cost ratio (BCR) was calculated to determine study objective.ResultsA total of 135 out of 235 participants (57.4%) responded to the WTP question. Of this subset, 111 participants (82.2%) preferred RDT before malaria treatment. Average WTP [minimum–maximum] was US$1.23 [US$0.0–US$5.03]. Educated participants had 1.8 times higher odds of WTP for RDT. Participants that understood RDT as described in the questionnaire had 18.3 times higher odds of WTP for RDT compared to participants that did not understand RDT as described in the questionnaire. Additionally, a unit increase in level of education (e.g. from primary to secondary school) led to US$0.298 increase in WTP amount for RDT. Also, a unit increase in malaria frequency (e.g. from ‘never’ to ‘rarely’) led to US$0.293 decrease in WTP amount for RDT. Average cost [minimum–maximum] of RDT test kit and pharmacist time spent in administering the test were US$0.15 [US$0.13–US$0.17] and US$0.41 [US$0.18–US$0.52], respectively. BCR of test-based malaria treatment was 6.7 (95% CI 6.4–7.0).ConclusionTest-based malaria treatment is cost-beneficial for pharmacy practitioners. This finding could be used as an advocacy tool to increase community pharmacists’ interest and uptake of test-based malaria treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1648-0) contains supplementary material, which is available to authorized users.

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“…The health system challenge of perennial shortages of mRDT and other commodities needs to be fixed. [50][51][52] Government-or donor-supported interventions aimed at addressing similar challenges often involve free supply of such commodities. Such interventions are difficult to sustain in the midst of competing health needs and are stopped when funds are depleted.…”

Section: Discussionmentioning

confidence: 99%

The Accuracy and Perception of Test-Based Management of Malaria at Private Licensed Chemical Shops in the Middle Belt of Ghana

Kwarteng

Malm

Febir

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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The sale of artemisinin-based combination therapy (ACT) by private licensed chemical shops (LCS) without testing is contrary to current policy recommendations. This study assessed the accuracy and perception of test-based management of malaria using malaria rapid diagnostic test (mRDT) kits at private LCS in two predominantly rural areas in the middle part of Ghana. Clients presenting at LCS with fever or other signs and symptoms suspected to be malaria in the absence of signs of severe malaria were tested with mRDT by trained attendants and treated based on the national malaria treatment guidelines. Using structured questionnaires, exit interviews were conducted within 48 hours and a follow-up interview on day 7 (±3 days). Focus group discussions and in-depth interviews were also conducted to assess stakeholders' perception on the use of mRDT at LCS. About 79.0% (N = 1,797) of clients reported with a fever. Sixty-six percent (947/1,426) of febrile clients had a positive mRDT result. Eighty-six percent (815/947) of clients with uncomplicated malaria were treated with the recommended ACT. About 97.8% (790/808) of clients with uncomplicated malaria treated with ACT were reported to be well by day 7. However, referral for those with negative mRDT results was very low (4.1%, 27/662). A high proportion of clients with a positive mRDT result received the recommended malaria treatment. Testbased management of malaria by LCS attendants was found to be feasible and acceptable by the community members and other stakeholders. Successful implementation will however require effective referral, supervision and quality control systems.

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Shifting from Presumptive to Test-Based Management of Malaria - Technical Basis and Implications for Malaria Control in Ghana

Cited by 21 publications

References 81 publications

Prevalence of Malaria Positive Rapid Diagnostic Test and Antimalarial Treatment in Patients with Fevers in the Accident and Emergency Unit of Effia Nkwanta Regional Hospital, Western Region, Ghana

Prevalence of Malaria Positive Rapid Diagnostic Test and Antimalarial Treatment in Patients with Fevers in the Accident and Emergency Unit of Effia Nkwanta Regional Hospital, Western Region, Ghana

Cost benefit analysis of malaria rapid diagnostic test: the perspective of Nigerian community pharmacists

The Accuracy and Perception of Test-Based Management of Malaria at Private Licensed Chemical Shops in the Middle Belt of Ghana

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