Use and limitations of malaria rapid diagnostic testing by community health workers in war-torn Democratic Republic of Congo.
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.
Hawkes
Michael
M
University of Toronto, 101 College St, Suite 10-401, Toronto, Ontario, Canada. michael.hawkes@utoronto.ca
Katsuva
Jean Paul
JP
Masumbuko
Claude K
CK
D000328:Adult; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D006282:Health Personnel; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data*; D012424:Rural Population; D011795:Surveys and Questionnaires; D014857:Warfare; D055815:Young Adult