Low-technology cooling box for storage of malaria RDTs and other medical supplies in remote areas.
BACKGROUND
With the increase in use of point-of-care diagnostic tests for malaria and other diseases comes the necessity of storing the diagnostic kits and the drugs required for subsequent management, in remote areas, where temperatures are high and electricity supply is unreliable or unavailable.


METHODS
To address the lack of temperature-controlled storage during the introduction of community-based malaria management in Cambodia, the Cambodian National Centre for Parasitology, Entomology and Malaria Control (CNM) developed prototype evaporative cooling boxes (Cambodian Cooler Boxes - CCBs) for storage of perishable medical commodities in remote clinics. The performance of these CCBs for maintaining suitable storage temperatures was evaluated over two phases in 2005 and 2006-7, comparing conditions in CCBs using water as designed, CCBs with no water for evaporation, and ambient storage room temperatures. Temperature and humidity was monitored, together with the capacity of the RDTs recommended for storage between 2 to 30 degree Celsius to detect low-density malaria parasite samples after storage under these conditions.


RESULTS
Significant differences were recorded between the proportion of temperatures within the recommended RDT storage conditions in the CCBs with water and the temperatures in the storage room (p < 0.001) and maximum temperatures were lower. RDTs stored at ambient temperatures were negative when tested with parasitized blood (2,000 parasites per micro litre) at 210 days, while the field RDTs kept in CCBs with water gave positive results until 360 days.


CONCLUSIONS
The CCB was an effective tool for storage of RDTs at optimal conditions, and extended the effective life-span of the tests. The concept of evaporative cooling has potential to greatly enhance access to perishable diagnostics and medicines in remote communities, as it allows prolonged storage at low cost using locally-available materials, in the absence of electricity.
Chanthap
Lon
L
Foundation for Innovative New Diagnostics (FIND), 16 Avenue de Budé, 1202 Geneva, Switzerland.
Ariey
Frédéric
F
Socheat
Duong
D
Tsuyuoka
Reiko
R
Bell
David
D
D000818:Animals; D002160:Cambodia; D003955:Diagnostic Tests, Routine / Q000592:standards*; D004356:Drug Storage / Q000379:methods*; D006801:Humans; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000517:prevention & control; D010963:Plasmodium falciparum; D019095:Point-of-Care Systems; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods; D011933:Reagent Kits, Diagnostic / Q000592:standards* / Q000600:supply & distribution; D012015:Reference Standards; D013048:Specimen Handling / Q000295:instrumentation; D013696:Temperature
D011933:Reagent Kits, Diagnostic