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.
