title: Minimising human error in malaria rapid diagnosis: clarity of written instructions and health worker performance.
abstract: The usefulness of rapid diagnostic tests (RDT) in malaria case management depends on the accuracy of the diagnoses they provide. Despite their apparent simplicity, previous studies indicate that RDT accuracy is highly user-dependent. As malaria RDTs will frequently be used in remote areas with little supervision or support, minimising mistakes is crucial. This paper describes the development of new instructions (job aids) to improve health worker performance, based on observations of common errors made by remote health workers and villagers in preparing and interpreting RDTs, in the Philippines and Laos. Initial preparation using the instructions provided by the manufacturer was poor, but improved significantly with the job aids (e.g. correct use both of the dipstick and cassette increased in the Philippines by 17%). However, mistakes in preparation remained commonplace, especially for dipstick RDTs, as did mistakes in interpretation of results. A short orientation on correct use and interpretation further improved accuracy, from 70% to 80%. The results indicate that apparently simple diagnostic tests can be poorly performed and interpreted, but provision of clear, simple instructions can reduce these errors. Preparation of appropriate instructions and training as well as monitoring of user behaviour are an essential part of rapid test implementation.
authors.affiliation: Quality Assurance Project, Bethesda, MD 20814-4811, USA.
authors.forename: Waverly
authors.initials: W
authors.lastname: Rennie
authors.forename: Rattanaxay
authors.initials: R
authors.lastname: Phetsouvanh
authors.forename: Socorro
authors.initials: S
authors.lastname: Lupisan
authors.forename: Viengsay
authors.initials: V
authors.lastname: Vanisaveth
authors.forename: Bouasy
authors.initials: B
authors.lastname: Hongvanthong
authors.forename: Samlane
authors.initials: S
authors.lastname: Phompida
authors.forename: Portia
authors.initials: P
authors.lastname: Alday
authors.forename: Mila
authors.initials: M
authors.lastname: Fulache
authors.forename: Richard
authors.initials: R
authors.lastname: Lumagui
authors.forename: Pernille
authors.initials: P
authors.lastname: Jorgensen
authors.forename: David
authors.initials: D
authors.lastname: Bell
authors.forename: Steven
authors.initials: S
authors.lastname: Harvey
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003951:Diagnostic Errors; D005260:Female; D006282:Health Personnel / Q000193:education / Q000592:standards*; D006801:Humans; D016778:Malaria, Falciparum / Q000175:diagnosis*; D008297:Male; D008488:Medical Illustration; D010174:Pamphlets; D011933:Reagent Kits, Diagnostic / Q000592:standards
chemical_list: D011933:Reagent Kits, Diagnostic