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. 2009 Dec 23:8:308.
doi: 10.1186/1475-2875-8-308.

Use and limitations of malaria rapid diagnostic testing by community health workers in war-torn Democratic Republic of Congo

Michael Hawkes  1 , Jean Paul Katsuva, Claude K Masumbuko
Affiliations

Use and limitations of malaria rapid diagnostic testing by community health workers in war-torn Democratic Republic of Congo

Michael Hawkes et al. Malar J. .

Abstract

Background: Accurate and practical malaria diagnostics, such as immunochromatographic rapid diagnostic tests (RDTs), have the potential to avert unnecessary treatments and save lives. Volunteer community health workers (CHWs) represent a potentially valuable human resource for expanding this technology to where it is most needed, remote rural communities in sub-Saharan Africa with limited health facilities and personnel. This study reports on a training programme for CHWs to incorporate RDTs into their management strategy for febrile children in the Democratic Republic of Congo, a tropical African setting ravaged by human conflict.

Methods: Prospective cohort study, satisfaction questionnaire and decision analysis.

Results: Twelve CHWs were trained to safely and accurately perform and interpret RDTs, then successfully implemented rapid diagnostic testing in their remote community in a cohort of 357 febrile children. CHWs were uniformly positive in evaluating RDTs for their utility and ease of use. However, high malaria prevalence in this cohort (93% by RDTs, 88% by light microscopy) limited the cost-effectiveness of RDTs compared to presumptive treatment of all febrile children, as evidenced by findings from a simplified decision analysis.

Conclusions: CHWs can safely and effectively use RDTs in their management of febrile children; however, cost-effectiveness of RDTs is limited in zones of high malaria prevalence.

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Figures

Figure 1
Figure 1
A simple decision analysis demonstrated elevated cost/utility ratio of rapid diagnostic testing (RDT) strategy at high malaria prevalence, in a hypothetical cohort of 100 febrile children. A. Decision analysis tree. Among simplifying assumptions (*), the cost of false negative malaria tests is neglected (given high test specificity and high disease prevalence). B. Equation relating the trade-off of increased cost but reduced number of unnecessary treatment courses associated with a strategy of RDT. C. Cost of two strategies (RDT, solid line versus presumptive treatment, dashed line) over a range of malaria prevalence. D. The cost of averting one unnecessary treatment with RDT rises steeply at high prevalence. NMFI, non-malaria febrile illness; TP, true positive; TN, true negative; FP, false positive; FN, false negative; cdx, cost of rapid diagnostic test; ctx, cost of treatment course; sens, sensitivity; spec, specificity; prev, prevalence.
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References

    1. Snow RW, Guerra CA, Noor AM, Myint HY, Hay SI. The global distribution of clinical episodes of Plasmodium falciparum malaria. Nature. 2005;434:214–217. doi: 10.1038/nature03342. - DOI - PMC - PubMed
    1. World Health Organization. Global Malaria Programme. http://www.who.int/malaria
    1. Coghlan B, Ngoy P, Mulumba F, Hardy C, Bemo VN, Stewart T, Lewis J, Brennan RJ. Update on mortality in the Democratic Republic of Congo: results from a third nationwide survey. Disaster Med Public Health Prep. 2009;3:88–96. doi: 10.1097/DMP.0b013e3181a6e952. - DOI - PubMed
    1. Coghlan B, Brennan RJ, Ngoy P, Dofara D, Otto B, Clements M, Stewart T. Mortality in the Democratic Republic of Congo: a nationwide survey. Lancet. 2006;367:44–51. doi: 10.1016/S0140-6736(06)67923-3. - DOI - PubMed
    1. Amexo M, Tolhurst R, Barnish G, Bates I. Malaria misdiagnosis: effects on the poor and vulnerable. Lancet. 2004;364:1896–1898. doi: 10.1016/S0140-6736(04)17446-1. - DOI - PubMed

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