Improved diagnostic testing and malaria treatment practices in Zambia

CONTEXT: Improving the accuracy of malaria diagnosis with rapid antigen-detection diagnostic tests (RDTs) has been proposed as an approach for reducing overtreatment of malaria in the current era of widespread implementation of artemisinin-based combination therapy in sub-Saharan Africa. OBJECTIVE: To assess the association between use of microscopy and RDT and the prescription of antimalarials. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional, cluster sample survey, carried out between March and May 2006, of all outpatients treated during 1 working day at government and mission health facilities in 4 sentinel districts in Zambia. MAIN OUTCOME MEASURE: Proportions of patients undergoing malaria diagnostic procedures and receiving antimalarial treatment. RESULTS: Seventeen percent of the 104 health facilities surveyed had functional microscopy, 63% had RDTs available, and 73% had 1 or more diagnostics available. Of patients with fever (suspected malaria), 27.8% (95% confidence interval [CI], 13.1%-42.5%) treated in health facilities with malaria diagnostics were tested and 44.6% had positive test results. Of patients with negative blood smear results, 58.4% (95% CI, 36.7%-80.2%) were prescribed an antimalaria drug, as were 35.5% (95% CI, 16.0%-55.0%) of those with a negative RDT result. Of patients with fever who did not have diagnostic tests done, 65.9% were also prescribed antimalarials. In facilities with artemether-lumefantrine in stock, this antimalarial was prescribed to a large proportion of febrile patients with a positive diagnostic test result (blood smear, 75.0% [95% CI, 51.7%-98.3%]; RDT, 70.4% [95% CI, 39.3%-100.0%]), but also to some of those with a negative diagnostic test result (blood smear, 30.4% [95% CI, 8.0%-52. 9%]; RDT, 26.7% [95% CI, 5.7%-47.7%]). CONCLUSIONS: Despite efforts to expand the provision of malaria diagnostics in Zambia, they continue to be underused and patients with negative test results frequently receive antimalarials. Provision of new tools to reduce inappropriate use of new expensive antimalarial treatments must be accompanied by a major change in clinical treatment of patients presenting with fever but lacking evidence of malaria infection.

Hamer, Davidson H.
Ndhlovu, Micky
Zurovac, Dejan
Fox, Matthew
Yeboah-Antwi, Kojo
Chanda, Pascalina
Sipilinyambe, Naawa
Simon, Jonathon L.
Snow, Robert W.
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Journal Article
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PMID: 17519412 PMCID: PMC2674546

Turabian/Chicago Citation

Davidson H. Hamer, Micky Ndhlovu, Dejan Zurovac, Matthew Fox, Kojo Yeboah-Antwi, Pascalina Chanda, Naawa Sipilinyambe, Jonathon L. Simon and Robert W. Snow. 5/23/2007. "Improved diagnostic testing and malaria treatment practices in Zambia." JAMA 297: 20: 2227-2231. 10.1001/jama.297.20.2227.

Wikipedia Citation

<ref> {{Cite journal | doi = 10.1001/jama.297.20.2227 | issn = 1538-3598 | volume = 297 | pages = 2227-2231 | last = Hamer | first = Davidson H. | coauthors = Ndhlovu, Micky, Zurovac, Dejan, Fox, Matthew, Yeboah-Antwi, Kojo, Chanda, Pascalina, Sipilinyambe, Naawa, Simon, Jonathon L., Snow, Robert W. | title = Improved diagnostic testing and malaria treatment practices in Zambia | journal = JAMA | date = 5/23/2007 | pmid = | pmc = }} </ref>