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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Getting antimalarials on target: Impact of national roll-out of malaria rapid diagnostic tests on health facility treatment in three regions of Tanzania
Tropical Medicine and International Health, Volume 18, No. 10, Year 2013
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Description
Objectives: Parasitological confirmation of malaria prior to treatment is recommended for patients of all ages, with malaria rapid diagnostic tests (mRDTs) an important tool to target artemisinin-based combination therapies (ACTs) to patients with malaria. To evaluate the impact on case management practices of routine government implementation of mRDTs, we conducted large-scale health facility surveys in three regions of Tanzania before and after mRDT roll-out. Methods: Febrile patients at randomly selected health facilities were interviewed about care received at the facility, and blood samples were collected for reference blood smears. Health facility staff were interviewed about their qualifications and availability of malaria diagnostics and drugs. Results: The percentage of febrile patients tested for malaria at the facility increased from 15.8% in 2010 to 54.9% in 2012. ACTs were obtained by 65.8% of patients positive by reference blood smear in 2010 and by 50.2% in 2012 (P = 0.0675); no antimalarial was obtained by 57.8% of malaria-negative patients in 2010 and by 82.3% in 2012 (P < 0.0001). Overall, ACT use decreased (39.9-21.3%, P < 0.0001) and antibiotic use increased (31.2-48.5%, P < 0.0001). Conclusion: Roll-out of mRDTs in Tanzania dramatically improved diagnostic testing for malaria and reduced overuse of ACTs for patients without parasitemia. However, post-roll-out almost 50% of febrile patients did not receive a diagnostic test, and almost 50% of patients testing positive did not receive ACTs. Stock-outs of ACTs and mRDTs were important problems. Further investigation is needed to determine reasons for not providing ACTs to patients with malaria and potential for inappropriate antibiotic use. © 2013 John Wiley & Sons Ltd.
Authors & Co-Authors
Bruxvoort, Katia J.
Unknown Affiliation
Kalolella, Admirabilis Beno
Unknown Affiliation
Nchimbi, Happy
Unknown Affiliation
Festo, Charles
Unknown Affiliation
Taylor, Mark Steven
Unknown Affiliation
Thomson, Rebecca M.
Unknown Affiliation
Cairns, Matthew E.
Unknown Affiliation
Thwing, Julie I.
Unknown Affiliation
Kleinschmidt, Immo
Unknown Affiliation
Goodman, Catherine A.
Unknown Affiliation
Kachur, Stephen Patrick
Unknown Affiliation
Statistics
Citations: 54
Authors: 11
Affiliations: 4
Identifiers
Doi:
10.1111/tmi.12168
ISSN:
13602276
e-ISSN:
13653156
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Study Locations
Tanzania