title: Rapid malaria diagnostic tests vs. clinical management of malaria in rural Burkina Faso: safety and effect on clinical decisions. A randomized trial.
abstract: OBJECTIVE
  To assess if the clinical outcome of patients treated after performing a Rapid Diagnostic Test for malaria (RDT) is at least equivalent to that of controls (treated presumptively without test) and to determine the impact of the introduction of a malaria RDT on clinical decisions.
  
  
  METHODS
  Randomized, multi-centre, open clinical trial in two arms in 2006 at the end of the dry and of the rainy season in 10 peripheral health centres in Burkina Faso: one arm with use of RDT before treatment decision, one arm managed clinically. Primary endpoint: persistence of fever at day 4. Secondary endpoints: frequency of malaria treatment and of antibiotic treatment.
  
  
  RESULTS
  A total of 852 febrile patients were recruited in the dry season and 1317 febrile patients in the rainy season, and randomized either to be submitted to RDT (P_RTD) or to be managed presumptively (P_CLIN). In both seasons, no significant difference was found between the two randomized groups in the frequency of antimalarial treatment, nor of antibiotic prescription. In the dry season, 80.8% and 79.8% of patients with a negative RDT were nevertheless diagnosed and treated for malaria, and so were 85.0% and 82.6% negative patients in the rainy season. In the rainy season only, both diagnosis and treatment of other conditions were significantly less frequent in RDT positive vs. negative patients (48.3% vs. 61.4% and 46.2% vs. 59.9%, P = 0.00 and 0.00, respectively).
  
  
  CONCLUSIONS
  Our study was inconclusive on RDT safety (clinical outcome in the two randomized groups), because of an exceedingly and unexpectedly low compliance with the negative test result. Further research is needed on best strategies to promote adherence and on the safety of a test based strategy compared with the current, presumptive treatment strategy.
authors.affiliation: Centre for Tropical Diseases, Sacro Cuore Hospital, Negrar (Verona), Italy. zeno.bisoffi@sacrocuore.it
authors.forename: Zeno
authors.initials: Z
authors.lastname: Bisoffi
authors.forename: Bienvenu Sodiomon
authors.initials: BS
authors.lastname: Sirima
authors.forename: Andrea
authors.initials: A
authors.lastname: Angheben
authors.forename: Claudia
authors.initials: C
authors.lastname: Lodesani
authors.forename: Federico
authors.initials: F
authors.lastname: Gobbi
authors.forename: Halidou
authors.initials: H
authors.lastname: Tinto
authors.forename: Jef
authors.initials: J
authors.lastname: Van den Ende
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D002050:Burkina Faso; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000188:drug therapy; D006282:Health Personnel / Q000193:education; D006801:Humans; D007223:Infant; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011933:Reagent Kits, Diagnostic / Q000592:standards*; D012423:Rural Health; D012621:Seasons; D055815:Young Adult
chemical_list: D000962:Antimalarials; D011933:Reagent Kits, Diagnostic