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- - - Malaria Rapid Testing by Community Health Workers is Effective and Safe for Targeting Malaria Treatment

Sunday, 24th of March 2013

• MALARIA RAPID TESTING BY COMMUNITY HEALTH WORKERS IS EFFECTIVE AND SAFE FOR TARGETING MALARIA TREATMENT: RANDOMISED CROSS-OVER TRIAL IN TANZANIA

Abstract below; full text is at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0019753

Marycelina Mubi,

Affiliations: Department of Parasitology, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, Unit of Infectious Diseases, Department of Medicine Solna, Karolinska University Hospital/Karolinska Institutet, Stockholm, Sweden

Annika Janson,

Affiliation: Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden

Marian Warsame,

Affiliation: Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

Andreas Mårtensson,

Affiliation: Unit of Infectious Diseases, Department of Medicine Solna, Karolinska University Hospital/Karolinska Institutet, Stockholm, Sweden

Karin Källander,

Affiliation: Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

Max G. Petzold,

Affiliation: Nordic School of Public Health, Gothenburg, Sweden

Billy Ngasala,

Affiliations: Unit of Infectious Diseases, Department of Medicine Solna, Karolinska University Hospital/Karolinska Institutet, Stockholm, Sweden, National Institute of Medical Research, Dar es Salaam, Tanzania

Gloria Maganga,

Affiliation: Department of Parasitology, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

Lars L. Gustafsson,

Affiliation: Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden

Amos Massele,

Affiliation: Department of Clinical Pharmacology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

Göran Tomson,

Affiliation: Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

Zul Premji,

Affiliation: Department of Parasitology, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

Anders Björkman mail

* E-mail: anders.bjorkman@karolinska.se

Affiliation: Unit of Infectious Diseases, Department of Medicine Solna, Karolinska University Hospital/Karolinska Institutet, Stockholm, Sweden

Abstract

Background

Early diagnosis and prompt, effective treatment of uncomplicated malaria is critical to prevent severe disease, death and malaria transmission. We assessed the impact of rapid malaria diagnostic tests (RDTs) by community health workers (CHWs) on provision of artemisinin-based combination therapy (ACT) and health outcome in fever patients.

Methodology/Principal Findings

Twenty-two CHWs from five villages in Kibaha District, a high-malaria transmission area in Coast Region, Tanzania, were trained to manage uncomplicated malaria using RDT aided diagnosis or clinical diagnosis (CD) only. Each CHW was randomly assigned to use either RDT or CD the first week and thereafter alternating weekly. Primary outcome was provision of ACT and main secondary outcomes were referral rates and health status by days 3 and 7. The CHWs enrolled 2930 fever patients during five months of whom 1988 (67.8%) presented within 24 hours of fever onset. ACT was provided to 775 of 1457 (53.2%) patients during RDT weeks and to 1422 of 1473 (96.5%) patients during CD weeks (Odds Ratio (OR) 0.039, 95% CI 0.029–0.053). The CHWs adhered to the RDT results in 1411 of 1457 (96.8%, 95% CI 95.8–97.6) patients. More patients were referred on inclusion day during RDT weeks (10.0%) compared to CD weeks (1.6%). Referral during days 1–7 and perceived non-recovery on days 3 and 7 were also more common after RDT aided diagnosis. However, no fatal or severe malaria occurred among 682 patients in the RDT group who were not treated with ACT, supporting the safety of withholding ACT to RDT negative patients.

Conclusions/Significance

RDTs in the hands of CHWs may safely improve early and well-targeted ACT treatment in malaria patients at community level in Africa.

Trial registration

ClinicalTrials.gov NCT00301015

Citation: Mubi M, Janson A, Warsame M, Mårtensson A, Källander K, et al. (2011) Malaria Rapid Testing by Community Health Workers Is Effective and Safe for Targeting Malaria Treatment: Randomised Cross-Over Trial in Tanzania. PLoS ONE 6(7): e19753. doi:10.1371/journal.pone.0019753

Editor: François Nosten, Mahidol University, Thailand

Received: December 3, 2010; Accepted: April 15, 2011; Published: July 5, 2011

Copyright: © 2011 Mubi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The study was financed by Sida/SAREC in the framework of a collaborative Malaria Project between Muhimbili University of Health and Allied Sciences and Karolinska Institutet (Bil-T2 16/9875007059). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.