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Adding rapid diagnostic tests to community-based programmes for treating malaria.

Elizabeth N Allen1, Alison Beriliy Wiyeh2, Michael McCaul3

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|September 8, 2022
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Summary
This summary is machine-generated.

Community health workers using malaria rapid diagnostic tests (mRDTs) reduce unnecessary antimalarial prescriptions for non-malaria cases. While mRDTs improve appropriate treatment, antibiotic use may increase, with no significant impact on mortality observed.

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Area of Science:

  • Global Health
  • Infectious Diseases
  • Diagnostic Accuracy

Background:

  • The World Health Organization (WHO) recommends diagnostic testing before malaria treatment.
  • Community health workers (CHWs) are increasingly involved in malaria case management.
  • This review updates previous findings on community-based malaria diagnosis and treatment.

Purpose of the Study:

  • To evaluate community-based management strategies for malaria or fever.
  • To assess the impact of malaria rapid diagnostic tests (mRDTs) used by CHWs.
  • To determine appropriate antimalarial treatment based on mRDT results.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies.
  • Included studies compared mRDT-based management by CHWs and drug shop vendors versus clinical diagnosis or routine care.
  • Primary outcomes included all-cause mortality, hospitalizations, and timely antimalarial treatment.

Main Results:

  • mRDT use by CHWs significantly reduced antimalarial prescriptions for individuals testing negative for malaria (moderate-certainty evidence).
  • mRDTs improved appropriate treatment, ensuring antimalarials for positive cases and avoiding them for negative cases (high-certainty evidence).
  • Antibiotic prescribing increased with mRDT use compared to clinical diagnosis (moderate-certainty evidence); no effect on mortality was demonstrated.

Conclusions:

  • Community-based mRDT use by CHWs and drug shop vendors effectively reduces inappropriate antimalarial prescribing.
  • While mRDTs enhance appropriate malaria treatment, they may lead to increased antibiotic use.
  • Further research is needed to fully understand the impact on mortality and other outcomes.