Restricting ACT drugs to patients with positive rapid diagnostic test results
[Project summary in Français / Português]
Scientific title: Effects of Restricting the Use of Artesunate Plus Amodiaquine Combination Therapy to Malaria Cases Confirmed by a Dipstick Test: A Cluster Randomised Control Trial (RDT-ACT)
Latest on this research
This study has made it possible for us to know with greater certainty the effect of restricting antimalarial to only children confirmed to have malaria. This includes how frequently they will get malaria or anaemia, and how this will impact on the prescriptions of other drugs.
Various sub-aspects of the study have been presented to national stakeholders, peresented at international conferences and published in various journals. We are currently preparing the final publications.
Scroll down for related resources, including a publication on the main findings of this study: Effect of test-based versus presumptive treatment of malaria in under-five children in rural Ghana - A cluster-randomised trial (PLOS ONE).
What did we know before this research?
In sub-Saharan Africa it is common to overdiagnose and overtreat malaria, which means that patients who are not formally diagnosed with malaria are still considered to have the disease and therefore receive anti-malarial treatment. This leads to the waste of expensive drugs and increases the risk of developing drug resistance.
The over-diagnosis of malaria happens mainly due to the lack of diagnostic tools that could be readily used at point of care. Also, overprescribing antimalarials was thought to have the beneficial effect of protecting even children who did not have malaria.
The availability of rapid diagnostic tests (RDT) for malaria restricts the prescription of antimalarials to children who are confirmed to have malaria through an RDT. This could reduce the number of children who are prescribed antimalarial and possibly put more children at increased risk of malaria as they will not benefit from its preventive effect (known as prophylaxis).
What does this study add?
In this study we have tested the effects of providing ACT drugs only to patients who did a rapid diagnostic test and whose result was positive. This approach could improve the treatment of malaria, as well as support health services to better manage non-malaria illnesses that also cause fever. One example is pneumonia, which is often misdiagnosed as malaria in children. Finally, this system could also reduce the use of anti-malarials and consequently the risk of developing drug resistance.
We have assessed the accuracy of rapid diagnostic tests and the outcomes of treatment based on RDT results in 32 health facilities. The team conducted interviews with health providers to understand their diagnostic and treatment decisions, as well as exit interviews with carers of children under five years old presenting fever to assess their satisfaction with the treatment received.
The research team
Principal Investigators
- Prof. Daniel Chandramohan, London School of Hygiene & Tropical Medicine
Email: Daniel.chandramohan@lshtm.ac.uk
- Dr. Seth Owusu-Agyei, Kintampo Health Research Centre, Kintampo
- Ms. Jayne Webster, London School of Hygiene and Tropical Medicine
- Dr. Frank Baiden, Kintampo Health Research Centre, Kintampo
Other Investigators
- Ms. Jane Bruce, London School of Hygiene and Tropical Medicine
Related Publications
Acceptability of Rapid Diagnostic Test-based management of Malaria among caregivers of under-five children in rural Ghana
Frank Baiden, Seth Owusu-Agyei, Eunice Okyere, Mathilda Tivura, George Adjei, Daniel Chandramohan, Jayne Webster | Published
PLoS ONE
Accuracy of rapid tests for Malaria and treatment outcomes for Malaria and non-Malaria cases among under-five children in rural Ghana
Frank Baiden, Jayne Webster, Mathilda Tivura, Rupert Delimini, Yvonne Berko, Seeba Amenga- Etego, Akua Agyeman-Budu, Akosua B. Karikari, Jane Bruce, Seth Owusu-Agyei, Daniel Chandramohan | Published
PLoS ONE
An evaluation of the clinical assessments of under-five febrile children presenting to primary health facilities in rural Ghana
Frank Baiden, Seth Owusu-Agyei, Justina Bawah, Jane Bruce, Mathilda Tivura, Rupert Delmini, Stephaney Gyaase, Seeba Amenga-Etego, Daniel Chandramohan, Jayne Webster | Published
PLoS ONE
Would rational use of antibiotics be compromised in the era of test-based management of malaria?
Frank Baiden, Jayne Webster, Seth Owusu-Agyei, and Daniel Chandramohan | Published
Tropical Medicine and International Health
The need for new antibiotics
Frank Baiden, Seth Owusu-Agyei, Jayne Webster, Daniel Chandramohan | Published
The Lancet
Management of febrile children under five years in hospitals and health centres of rural Ghana
Jayne Webster, Frank Baiden, Justina Bawah, Jane Bruce, Mathilda Tivura, Rupert Delmini, Seeba Amenga-Etego, Daniel Chandramohan, Seth Owusu-Agyei | Published
Malaria Journal
Shifting from presumptive to test-based management of malaria - Technical basis and implications for malaria control in Ghana
F. Baiden, K. Malm, C. Bart-Plange, A. Hodgson, D. Chandramohan, J. Webster, S. Owusu-Agyei | Published
Ghana Medical Journal
Effect of test-based versus presumptive treatment of malaria in under-five children in rural Ghana - A cluster-randomised trial
Frank Baiden, Jane Bruce, Jayne Webster, Mathilda Tivura, Rupert Delmini, Seeba Amengo-Etego, Seth Owusu-Agyei and Daniel Chandramohan | Published
PLOS ONE
Examining intervention design: lessons from the development of eight related malaria health care intervention studies
Clare I.R. Chandler*, Helen Burchett, Louise Boyle, Olivia Achonduh, Anthony Mbonye, Deborah DiLiberto, Hugh Reyburn, Obinna Onwujekwe, Ane Haaland, Arantxa Roca-Feltrer, Frank Baiden, Wilfred F. Mbacham, Richard Ndyomugyenyi, Florence Nankya, Lindsay Man | Published
Health Systems and Reform