The impact of providing rapid diagnostic malaria tests on fever management in the private retail sector in Ghana: a cluster randomized trial

Ansah, Evelyn; Narh-Bana, Solomon; Bonful, Harriet Affran; Bart-Plange, Constance; Cundill, Bonnie; Gyapong, Margaret; Whitty, Christopher J M

doi:10.1136/bmj.h1019

Cited by 80 publications

(149 citation statements)

References 54 publications

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“…Studies in settings where antibiotics are not available to prescribers, such as chemist shops in Ghana, have shown that withholding both antibiotics and antimalarials diverts patients to antipyretics, which is a safe strategy for most uncomplicated illness. 57 With declining incidence of malaria in many settings, the proportion of fevers attributable to illnesses other than malaria stands to increase. Currently rapid diagnostic tests are more useful to rule out malaria than to rule it in, at least in Africa, but this is likely to change as the incidence of malaria drops.…”

Section: Strengths and Weaknesses Of Studymentioning

confidence: 99%

Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings

Hopkins

Bruxvoort

Cairns

et al. 2017

BMJ

110

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Objectives To examine the impact of use of rapid diagnostic tests for malaria on prescribing of antimicrobials, specifically antibiotics, for acute febrile illness in Africa and Asia.Design Analysisof nine preselected linked and codesigned observational and randomised studies (eight cluster or individually randomised trials and one observational study).Setting Public and private healthcare settings, 2007-13, in Afghanistan, Cameroon, Ghana, Nigeria, Tanzania, and Uganda.Participants 522 480 children and adults with acute febrile illness.Interventions Rapid diagnostic tests for malaria.Main outcome measures Proportions of patients for whom an antibiotic was prescribed in trial groups who had undergone rapid diagnostic testing compared with controls and in patients with negative test results compared with patients with positive results. A secondary aim compared classes of antibiotics prescribed in different settings.Results Antibiotics were prescribed to 127 052/238 797 (53%) patients in control groups and 167 714/283 683 (59%) patients in intervention groups. Antibiotics were prescribed to 40% (35 505/89 719) of patients with a positive test result for malaria and to 69% (39 400/57 080) of those with a negative result. All but one study showed a trend toward more antibiotic prescribing in groups who underwent rapid diagnostic tests. Random effects meta-analysis of the trials showed that the overall risk of antibiotic prescription was 21% higher (95% confidence interval 7% to 36%) in intervention settings. In most intervention settings, patients with negative test results received more antibiotic prescriptions than patients with positive results for all the most commonly used classes: penicillins, trimethoprim-sulfamethoxazole (one exception), tetracyclines, and metronidazole.Conclusions Introduction of rapid diagnostic tests for malaria to reduce unnecessary use of antimalarials—a beneficial public health outcome—could drive up untargeted use of antibiotics. That 69% of patients were prescribed antibiotics when test results were negative probably represents overprescription.This included antibiotics from several classes, including those like metronidazole that are seldom appropriate for febrile illness, across varied clinical, health system, and epidemiological settings. It is often assumed that better disease specific diagnostics will reduce antimicrobial overuse, but they might simply shift it from one antimicrobial class to another. Current global implementation of malaria testing might increase untargeted antibiotic use and must be examined.

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Section: Strengths and Weaknesses Of Studymentioning

confidence: 99%

Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings

Hopkins

Bruxvoort

Cairns

et al. 2017

BMJ

110

View full text Add to dashboard Cite

show abstract

“…In sub-Saharan Africa, most cases of uncomplicated malaria are treated presumptively on the basis of symptoms rather than a positive test or formal medical diagnosis, and treatment medication is purchased from a local store or pharmacy ( 30 ). Because of this, we conservatively assumed that disruption of health services from the Ebola outbreak only affected treatment for severe malaria.…”

Section: Methodsmentioning

confidence: 99%

Effects of Response to 2014–2015 Ebola Outbreak on Deaths from Malaria, HIV/AIDS, and Tuberculosis, West Africa

Parpia¹,

Ndeffo-Mbah²,

Wenzel³

et al. 2016

Emerg. Infect. Dis.

273

253

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“…12 Most of the population lives in scattered small communities of less than 2000 people. Vehicular transport is unavailable in many parts of the district and people have to walk long distances (approx.…”

Section: Methodsmentioning

confidence: 99%

“…A total of 56 chemical sellers and 6 pharmacies also sell pharmaceutical products and their diagnostic practice is described elsewhere. 12 Chemical sellers are regulated by law and supervised by the Pharmacy Council, which also regulates pharmacies. To be eligible to apply for a chemical seller's license, a person must possess a minimum qualification of General Certificate of Examination (GCE) Ordinary Level Certificate or a Senior Secondary School (SSS) Certificate with basic knowledge in healthcare delivery being an advantage.…”

Section: Methodsmentioning

confidence: 99%

Changes in the availability and affordability of subsidised artemisinin combination therapy in the private drug retail sector in rural Ghana: before and after the introduction of the AMFm subsidy

et al. 2016

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BackgroundMost people with febrile illness are treated in the private drug retail sector. Ghana was among nine countries piloting the Global Fund Affordable Medicines Facility – malaria (AMFm). AMFm aimed to: increase artemisinin combination therapy (ACT) affordability; increase ACT availability; increase ACT use; and ‘crowd out’ artemisinin monotherapies.MethodsThree censuses were carried out 2 months before (2010), 2 months after and 2.5 years after (2013) the first co-paid ACTs to assess changes in antimalarial (AM) availability and price in private retail shops in a Ghanaian rural district to assess the sustainability of the initial gains. Supply, stock-out and cost were explored.ResultsOf 62 shops in the district, 56 participated with 398, 388 and 442 brands of AMs in the shops during the 3 censuses. The proportion of ACTs increased over the period while monotherapies reduced. Herbal-based AM preparations comprised 40–45% of AMs in stock with minimal variation over the period. ACTs were the most sold AM type for all ages but overall buying and selling prices of Quality Assured-ACTs increased by 40–100%.ConclusionsInitial gains in ACT availability were sustained, but not improved on 2.5 years after AMFm. Widespread availability of unproven herbal medicines is a concern; AMFm had little impact on this.

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The impact of providing rapid diagnostic malaria tests on fever management in the private retail sector in Ghana: a cluster randomized trial

Cited by 80 publications

References 54 publications

Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings

Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings

Effects of Response to 2014–2015 Ebola Outbreak on Deaths from Malaria, HIV/AIDS, and Tuberculosis, West Africa

Changes in the availability and affordability of subsidised artemisinin combination therapy in the private drug retail sector in rural Ghana: before and after the introduction of the AMFm subsidy

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