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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Rapid diagnostic tests for the home-based management of malaria, in a high-transmission area
Annals of Tropical Medicine and Parasitology, Volume 103, No. 1, Year 2009
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Description
Rapid diagnostic tests (RDT) are sometimes recommended to improve the home-based management of malaria. The accuracy of an RDT for the detection of clinical malaria and the presence of malarial parasites has recently been evaluated in a high-transmission area of southern Mali. During the same study, the cost-effectiveness of a 'test-and-treat' strategy for the home-based management of malaria (based on an artemisinin-combination therapy) was compared with that of a 'treat-all' strategy. Overall, 301 patients, of all ages, each of whom had been considered a presumptive case of uncomplicated malaria by a village healthworker, were checked with a commercial RDT (Paracheck-Pf®). The sensitivity, specificity, and positive and negative predictive values of this test, compared with the results of microscopy and two different definitions of clinical malaria, were then determined. The RDT was found to be 82.9% sensitive (with a 95% confidence interval of 78.0%-87.1%) and 78.9% (63.9%-89.7%) specific compared with the detection of parasites by microscopy. In the detection of clinical malaria, it was 95.2% (91.3%-97.6%) sensitive and 57.4% (48.2%-66.2%) specific compared with a general practitioner's diagnosis of the disease, and 100.0% (94.5%-100.0%) sensitive but only 30.2% (24.8%-36.2%) specific when compared against the fulfillment of the World Health Organization's (2003) research criteria for uncomplicated malaria. Among children aged 0-5 years, the cost ofthe 'test-and-treat' strategy, per episode, was about twice that of the 'treat-all' (U.S.$1.0 v. U.S.$0.5). In older subjects, however, the two strategies were equally costly (approximately U.S.$2/episode). In conclusion, for children aged 0-5 years in a high-transmission area of sub-Saharan Africa, use of the RDT was not cost-effective compared with the presumptive treatment of malaria with an ACT. In older patients, use of the RDT did not reduce costs. The question remains whether either of the strategies investigated can be made affordable for the affected population. © The Liverpool School of Tropical Medicine 2009.
Authors & Co-Authors
Willcox, Merlin L.
Switzerland, Geneve
Antenna Technologies
United Kingdom, Oxford
Research Initiative on Traditional Antimalarial Methods
Sanogo, Fanta
Mali, Bamako
Institut National de Recherche en Sante Publique Mali
Graz, Bertrand
Switzerland, Geneve
Antenna Technologies
Switzerland, Lausanne
Institut Universitaire de Médecine Sociale et Préventive Lausanne
Forster, Mathieu
Canada
Bureau 4633
Canada, Quebec
Université Laval
Switzerland, Bern
University of Bern
Dakouo, F.
Mali, Bamako
Institut National de Recherche en Sante Publique Mali
Sidibé, Oumar
Mali, Bamako
Institut National de Recherche en Sante Publique Mali
Falquet, Jacques
Switzerland, Geneve
Antenna Technologies
Giani, Sergio
Unknown Affiliation
Diakité, Chiaka
Mali, Bamako
Institut National de Recherche en Sante Publique Mali
Diallo, Drissa
Mali, Bamako
Institut National de Recherche en Sante Publique Mali
Statistics
Citations: 35
Authors: 10
Affiliations: 7
Identifiers
Doi:
10.1179/136485909X384983
ISSN:
00034983
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Study Locations
Mali