Use of rapid diagnostic tests to improve malaria treatment in the community in Uganda
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[Project summary in Français / Português]
Scientific title: The role and cost-effectiveness of rapid diagnostic tests in home-based management of malaria using artemether-lumefantrine: a comparative study in two areas of high and low malaria transmission in rural Uganda
Latest on this research
Many community medicine distributors complied with the results of rapid diagnostic tests. The community were also aware that not all fever is caused by malaria, which increased the acceptability of the tests. As a result, the number of ACT treatments given reduced dramatically.
Read the paper published in Tropical Medicine and International Health with the results of this study: Appropriate targeting of artemisinin-based combination therapy by community health workers using malaria rapid diagnostic tests: Findings from randomized trials in two contrasting areas of high and low malaria transmission in south western Uganda
You can download the training manuals used in this study, as well as a policy brief and posters containing information on results. Please scroll down to see other resources.
What did we know before this research?
Most malaria deaths occur within 48 hours after the first symptoms appear. In rural areas, where access to health centres is poor, home-based management of malaria can reduce mortality caused by the disease by up to 50%. This approach provides training to selected members of the community to recognise the signs and symptoms of malaria in a child, and then to be able to give effective treatment near the patients’ home. This approach increases access to treatment, and ensures that children receive malaria treatment as quickly as possible.
In order to maximise the coverage and impact of artemisinin-based combination therapies (ACT), these drugs should be available not only in health centres but also in programmes of home-based management of malaria.
What does this study add?
Currently there is a significant over-use of antimalarial drugs. This happens because many cases of fever are immediately treated as malaria even without a blood test or laboratory confirmation. Since ACT drugs are generally more expensive than regular drugs, it is important that their use is restricted to people who are formally diagnosed with a blood test. This can be done by using rapid diagnostic tests (RDT), which don’t require electricity or qualified health staff.
This study evaluates whether the use of rapid diagnostic tests by community medicine distributors – with the aim to improve diagnosis and treatment of malaria in the community – is feasible, well accepted and cost-effective.
This cluster randomized trial compares two approaches. On the one hand, the new approach of using rapid diagnostic tests to diagnose malaria and, on the other hand, the current practice of treating patients with malaria drugs based solely on signs and symptoms (known as presumptive diagnosis).
This comparison aims to evaluate whether the use of rapid diagnostic tests in the management of fever within the community can improve the targeting of malaria treatment to those that need it most. The study also examines the impact of diagnostic testing on patients that do not have malaria, and whether a negative test result reduces unnecessary use of ACT medication and/or increases the likelihood of being referred to a qualified health care provider for more expert diagnosis. The evaluation is being carried out in areas of both low and high malaria transmission.
The research team
Principal Investigators
- Dr Richard Ndyomugyenyi, National Malaria Control Programme, Ministry of Health, Kampala, Uganda
Email: richardndyomugyenyi@yahoo.com
- Dr. Siân Clarke, London School of Hygiene & Tropical Medicine, UK
Email: Sian.clarke@lshtm.ac.uk
Other Investigators
- Dr Pascal Magnussen, DBL Institute for Health Research and Development, Faculty of Life Sciences, Copenhagen University, Frederiksberg, Denmark.
- Dr Kristian Schultz Hansen, London School of Hygiene and Tropical Medicine, Keppel St, London
Related Publications
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Joanna R, Deborah D, Lindsay M, Evelyn A, Sham L, Hilda M, Katia B, Jayne W, Lasse V, Shunmay Y, Toby L, Eleanor H, Hugh R, David L, David S, Bonnie C, Sarah S, Virginia W, Catherine G, Clare C | Published
Implementation Science
Health facility utilisation changes during the introduction of community case management of malaria in South Western Uganda: An interrupted time series approach
Sham Lal, Richard Ndyomugenyi, Neal D. Alexander, Mylene Lagarde, Lucy Paintain, Pascal Magnussen, Daniel Chandramohan, Sin E. Clarke | 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
Appropriate targeting of artemisinin-based combination therapy by community health workers using malaria rapid diagnostic tests: Findings from randomized trials in two contrasting areas of high and low malaria transmission in south western Uganda
Richard Ndyomugyenyi, Pascal Magnussen, Sham Lal, Kristian Hansen and Sian E Clarke | Published
Tropical Medicine and International Health