Using malaria rapid diagnostic tests in registered drug shops in a highly endemic region in Uganda substantially reduced overdiagnosis of malaria, improving the use of valuable malaria drugs, according to a new study published in PLOS ONE.
Most of the 15,000 patients that visited drug shops with a fever chose to buy an rapid diagnostic test when offered one by the trained vendors taking part in the study. Once they performed the test, results showed that less than 60% of the patients had malaria. The vendors usually complied with the test results, reducing overprescription of malaria drugs by 73%.
The researchers from the Artemisinin-based Combination Therapy (ACT) Consortium at the Ministry of Health in Uganda and the London School of Hygiene & Tropical Medicine in the UK carried out the study because up to 80% of malaria cases in Uganda are treated in the private sector.
The private sector is a common source of treatment in many other malaria-endemic areas, especially where there is poor access to public health facilities. Patients buy antimalarial drugs in shops to medicate themselves, although malaria is not always the cause of their fever, and thus inappropriate treatment is very common.
Lead author, Professor Anthony Mbonye from the Ugandan Ministry of Health, said: "Our findings show that it is feasible to collaborate with the private health sector and introduce malaria rapid diagnostic tests in drug shops. The next step is to refine the strategy and understand the cost implications of scaling it up in Uganda. Our long term aim is to provide evidence to help the World Health Organization develop guidance to improve malaria treatment in the private sector."
Dr Sian Clarke from the London School of Hygiene & Tropical Medicine, also a principal investigator in the research, said: "This study shows that rapid diagnostic tests can improve the use of artemisinin-based combination therapies - the most effective treatment for malaria - in drug shops, but it's not without its challenges. These tests alone will not improve the treatment of other diseases. We now need to continue working with the Ministry of Health to investigate how to improve our approach and expand it to other common illnesses."
At present, drug shop vendors usually treat patients based on their signs and symptoms without testing their blood for the presence of malaria parasites, as recommended by the World Health Organization. This can result in patients with a fever being overdiagnosed with malaria and purchasing a treatment which they don't need.
Rapid diagnostic tests are simple tools that require minimal training to diagnose malaria, providing an alternative to microscopy (a method that requires laboratory equipment and qualified staff). Rapid tests can help health workers and vendors in remote locations to prescribe the correct treatment for malaria.
An investigation conducted alongside the trial, published in Critical Public Health, found that despite their popularity, malaria tests were not a simple fix in the private sector. Patients welcomed the rapid diagnostic tests as well as government involvement in improving drug shops, and vendors "felt big" and more akin to qualified health workers in the public sector for being allowed to test blood. But researchers warn that this could give a false impression of vendors' other skills and services, and regulation by authorities is needed.
The team have recently received a new grant to investigate the feasibility of training and equipping registered drug shops to manage three key childhood diseases: malaria, pneumonia and diarrhoea.
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The ACT Consortium is funded by a grant from the Bill & Melinda Gates Foundation to London School of Hygiene & Tropical Medicine.
For more information or to request interviews contact the London School of Hygiene & Tropical Medicine press office on press@lshtm.ac.uk or+44 (0)20 7927 2802.
Notes to Editors:
- PLOS ONE publication: Mbonye AK, Magnussen P, Lal S, Hansen KS, Cundill B, Chandler C, et al. A Cluster Randomised Trial Introducing Rapid Diagnostic Tests into Registered Drug Shops in Uganda: Impact on Appropriate Treatment of Malaria. PLOS ONE. DOI:10.1371/journal.pone.0129545
- Critical Public Health publication: Hutchinson E, Chandler C, Clarke S, Lal S, Magnussen P, Kayendeke M, et al. 'It puts life in us and we feel big': shifts in the local health care system during the introduction of rapid diagnostic tests for malaria into drug shops in Uganda. Critical Public Health. DOI:10.1080/09581596.2014.886762
- Researchers introduced RDTs in 10 clusters of drug shops in Mukono district, central Uganda, and compared with 10 other clusters in the control arm, where treatment was given based on patients' signs and symptoms. The vendors' decision whether to treat a patient with Artemisinin-based combination therapy (ACT) - the treatment recommended by the World Health Organization for uncomplicated malaria - was validated by confirming the presence of malaria parasites in the patient's blood through microscopy carried out by the research team. Overdiagnosis and overprescription of malaria treatment was reduced by 73%, increasing appropriate treatment with ACT by 36%.
- Collaborating institutions: Ministry of Health, Kampala, Uganda; London School of Hygiene & Tropical Medicine, UK; University of Copenhagen, Denmark.
- Learn more about this research at http://www.actconsortium.org/RDTdrugshops
- Video available: interview with this study's principal investigators https://vimeo.com/76031268
- Related news story: Malaria testing not a simple fix in the private sector http://www.actconsortium.org/news.php/66/malaria-testing-not-a-simple-fix-in-the-private-sector
- Animation available: the wider problem of malaria diagnosis https://vimeo.com/109480993 (English); https://vimeo.com/125150730 (French); and https://vimeo.com/125548287 (Portuguese).
About the ACT Consortium
The ACT Consortium is an international research collaboration working on 25 projects in 10 countries to answer key questions on malaria drug delivery. Since initiating activities in 2008, the Consortium has been working to optimise the use of Artemisinin-based Combination Therapy (ACT), the first-line treatment for the most dangerous form of malaria recommended by the World Health Organization. The projects investigate ways to improve the access and targeting of ACTs, as well as assessing their safety and quality. The ACT Consortium is based at the London School of Hygiene & Tropical Medicine and a member of the School's Malaria Centre. http://www.actconsortium.org
About the London School of Hygiene & Tropical Medicine
The London School of Hygiene & Tropical Medicine is a world-leading centre for research and postgraduate education in public and global health, with 3,900 students and more than 1,000 staff working in over 100 countries. The School is one of the highest-rated research institutions in the UK, and was recently cited as the world's leading research-focused graduate school. Our mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice. http://www.lshtm.ac.uk
Journal
PLoS ONE