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.
