Comparative field performance and adherence to test results of four malaria rapid diagnostic tests among febrile patients more than five years of age in Blantyre, Malawi

Malaria Journal

Research

Ben Chilima¹  Jobiba Chinkhumba²  Don Mathanga³  Jacek Skarbinski⁴  Carl Campbell⁵  Miguel San Joaquin⁶  Victoria Ewing⁶  John Sande⁷  Doreen Ali⁷ 

[1] Community Health Sciences Unit, Ministry of Health, Lilongwe, Malawi;Malaria Alert Centre, College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi;Malaria Alert Centre, College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi;Department of Community Health, College of Medicine, Blantyre, Malawi;Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA;Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA;Center for Tropical and Global Emerging Diseases, University of Georgia, Athens, Georgia, USA;Malawi-Liverpool-Wellcome Trust, Blantyre, Malawi;National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi;

关键词: Malaria;    Health Worker;    Community Health Worker;    Parasite Density;    Asexual Parasite;   

DOI  :  10.1186/1475-2875-9-209

 received in 2010-05-26, accepted in 2010-07-20,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundMalaria rapid diagnostics tests (RDTs) can increase availability of laboratory-based diagnosis and improve the overall management of febrile patients in malaria endemic areas. In preparation to scale-up RDTs in health facilities in Malawi, an evaluation of four RDTs to help guide national-level decision-making was conducted.MethodsA cross sectional study of four histidine rich-protein-type-2- (HRP2) based RDTs at four health centres in Blantyre, Malawi, was undertaken to evaluate the sensitivity and specificity of RDTs, assess prescriber adherence to RDT test results and explore operational issues regarding RDT implementation. Three RDTs were evaluated in only one health centre each and one RDT was evaluated in two health centres. Light microscopy in a reference laboratory was used as the gold standard.ResultsA total of 2,576 patients were included in the analysis. All of the RDTs tested had relatively high sensitivity for detecting any parasitaemia [Bioline SD (97%), First response malaria (92%), Paracheck (91%), ICT diagnostics (90%)], but low specificity [Bioline SD (39%), First response malaria (42%), Paracheck (68%), ICT diagnostics (54%)]. Specificity was significantly lower in patients who self-treated with an anti-malarial in the previous two weeks (odds ratio (OR) 0.5; p-value < 0.001), patients 5-15 years old versus patients > 15 years old (OR 0.4, p-value < 0.001) and when the RDT was performed by a community health worker versus a laboratory technician (OR 0.4; p-value < 0.001). Health workers correctly prescribed anti-malarials for patients with positive RDT results, but ignored negative RDT results with 58% of patients with a negative RDT result treated with an anti-malarial.ConclusionsThe results of this evaluation, combined with other published data and global recommendations, have been used to select RDTs for national scale-up. In addition, the study identified some key issues that need to be further delineated: the low field specificity of RDTs, variable RDT performance by different cadres of health workers and the need for a robust quality assurance system. Close monitoring of RDT scale-up will be needed to ensure that RDTs truly improve malaria case management.

【 授权许可】

CC BY   
© Chinkhumba et al; licensee BioMed Central Ltd. 2010