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Diagnostic tests for malaria underused in Zambia

diagnostic procedure performed. Antimalarials were prescribed to 66 percent of these patients. About half of this group received artemether-lumefantrine (an artemisinin-based combination therapy).

In facilities with artemether-lumefantrine in stock, this antimalarial was prescribed to a large proportion of patients with fever with a positive diagnostic test result, but also to some with a negative diagnostic test result (blood smear, 30.4 percent; RDT, 26.7 percent).

"RDTs have been proposed as a cost-effective approach to reducing overtreatment of malaria; under current practice in Zambia, however, their use will not achieve this goal," the authors write.

"Given the widespread increase of artemisinin-based combination therapy in sub-Saharan Africa for management of uncomplicated malaria, there is a need to limit inappropriate use of these expensive new combinations. The increasing body of evidence that a substantial proportion of febrile patients do not have malaria, especially in low to moderate transmission zones, emphasizes the need to educate health center staff on the rational use of artemisinin-based combination therapy, which will require strengthening the availability of malaria diagnostics and enhancing quality control measures so that health care providers will have confidence in the test results."

"The RDT training program in Zambia needs to be restructured such that trainees are provided with clear instructions about how to respond to a negative test result. Without taking these steps, we may rapidly be confronted with widespread resistance of P falciparum to artemisinin-based combination therapy, and the lifespan of these highly effective new therapies will be reduced," the authors conclude.


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Contact: Lisa Brown
617-414-1401
JAMA and Archives Journals
22-May-2007


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