Effectiveness of Malaria Rapid Diagnostic Tests in fever patients attending primary health care facilities in Zanzibar

Professor Anders Björkman, MD, PhD

Malaria Research Unit, Department of Medicine/Solna, Scheelelab B2, Retzius väg 10 plan 5, Karolinska Institutet, SE-171 77 Stockholm, SwedenE-mail: anders.bjorkman@karolinska.se

Anders Björkman has 30 years of experience in Malaria research including some 200 publications in clinical, epidemiological and molecular aspects of malaria.

• Dr. Andreas Mårtensson, Karolinska Institutet
• MSc. Mwinyi I. Msellem, Zanzibar Malaria Control Program
• Mr. Abdullah S. Ali, Zanzibar Malaria Control Program
• Dr. Kristina Elfving, Karolinska Institutet
• Dr. Delér Shakely, Karolinska Institutet

Following the interventions with artemisinin-based combination therapy (ACT), long lasting insecticide treated nets (LLIN) and indoor residual spraying (IRS) during the last 6 years, Zanzibar has turned into a low transmission area with a marked decline of P. falciparum malaria among febrile children from approximately 30% to 1% or below and a reduction of crude child mortality of 50%. Based on these results the Zanzibar Ministry of Health and Social Welfare officially decided to change the target from control to elimination of malaria.

A prerequisite to reach this target is an efficacious system for malaria case detection and management, which can ensure improved targeting of ACT to patients with malaria infections. The restricted use of ACT to parasitologically confirmed malaria patients is critical. Overuse of ACTs will be a substantial financial burden on the health care system and spur antimalarial drug resistance with devastating effect on global malaria-control efforts and prevent other causes of fever from being appropriately treated.

RDTs are proposed to improve diagnostic efficiency also at the peripheral health care level beyond the reach of microscopy services. The recent introduction of RDT as policy in Zanzibar for confirmatory parasitological diagnosis in all public health facilities needs to be scientifically assessed. Importantly, the feasibility of incorporating RDT in febrile children in the Integrated Management of Childhood Illness algorithm, which is presently implemented in Zanzibar, needs to be scientifically evaluated.

Patient recruitment, sample collection, BS reading, PCR analyzes as well as data entry is now done. Data cleaning and analysis is ongoing.