Testing for malaria in Ugandan drug shops using a rapid diagnostic method managed to reduce over-prescription of malaria drugs by 73%, according to a study published in PLOS ONE.
“Inappropriate treatment of malaria is widely reported particularly in areas where there is poor access to health facilities and self-treatment of fevers with anti-malarial drugs bought in shops is the most common form of care-seeking,” authors of the study observe in the article.
Ugandans frequently rely on these private-sector venues to seek treatment for malaria. Oftentimes, however, the vendors in these registered drug shops fail to comply with World Health Organization (WHO) recommendations to test patients for evidence of malaria parasites before treating them with artemisinin-based combination therapy (ACT).
This can lead to malaria overdiagnosis and unnecessary treatment of patients who might not have the disease.
To better utilize ACT in these Ugandan drug shops, researchers in a cluster-randomized trial decided to introduce rapid diagnostic tests for malaria (mRDTs) in various parts of the country. The study’s trial took place in 20 geographical clusters of drug shops in a district in central Uganda. In 10 of these clusters, the protocol was to confirm the presence of malaria using an mRDT test, then follow up with ACT. Patients in the other 10 clusters were given ACT based on a presumption that a fever signified malaria.
“The primary outcome was the proportion of febrile patients receiving appropriate treatment with ACT defined as: malaria patients with microscopically-confirmed presence of parasites in a peripheral blood smear receiving ACT or rectal artesunate, and patients with no malaria parasites not given ACT,” the authors summarized in the PLOS ONE article.
From January until December 2011, treatment was administered to 15,517 eligible participants who presented with fever at these drug shops. Of the more than 8,600 patients in the intervention group, nearly all decided to purchase an mRDT, with nearly 59% testing positive for malaria.
More than 72% in the intervention group received appropriate ACT treatment for malaria, compared with just a third in the control group. Drug vendors in the meantime did their part to comply with the results of the rapid diagnostic test, reducing malaria treatment overutilization by approximately 73%.
“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,” Anthony Mbonye, director of clinical and community health services at Uganda’s Ministry of Health and lead author of the study, said in a statement issued by London School of Hygiene & Tropical Medicine.
Mbonye plans to provide these findings to WHO in the hopes that guidance can be developed to improve private-sector treatment of this disease.
A principal researcher in this trial cautioned against looking at the mRDT test as a silver bullet.
“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,” said Sian Clarke, PhD, senior lecturer in malaria research and control at the London School of Hygiene & Tropical Medicine.