title: Malaria diagnostic testing and treatment practices in three different Plasmodium falciparum transmission settings in Tanzania: before and after a government policy change.
abstract: BACKGROUND
  Patterns of decreasing malaria transmission intensity make presumptive treatment of malaria an unjustifiable approach in many African settings. The controlled use of anti-malarials after laboratory confirmed diagnosis is preferable in low endemic areas. Diagnosis may be facilitated by malaria rapid diagnostic tests (RDTs). In this study, the impact of a government policy change, comprising the provision of RDTs and advice to restrict anti-malarial treatment to RDT-positive individuals, was assessed by describing diagnostic behaviour and treatment decision-making in febrile outpatients <10 years of age in three hospitals in the Kagera and Mwanza Region in northern Tanzania.
  
  
  METHODS
  Prospective data from Biharamulo and Rubya Designated District Hospital (DDH) were collected before and after policy change, in Sumve DDH no new policy was implemented. Diagnosis of malaria was confirmed by RDT; transmission intensity was evaluated by a serological marker of malaria exposure in hospital attendees.
  
  
  RESULTS
  Prior to policy change, there was no evident association between the actual level of transmission intensity and drug-prescribing behaviour. After policy change, there was a substantial decrease in anti-malarial prescription and an increase in prescription of antibiotics. The proportion of parasite-negative individuals who received anti-malarials decreased from 89.1% (244/274) to 38.7% (46/119) in Biharamulo and from 76.9% (190/247) to 10.0% (48/479) in Rubya after policy change.
  
  
  CONCLUSIONS
  This study shows that an official policy change, where RDTs were provided and healthcare providers were advised to adhere to RDT results in prescribing drugs can be followed by more rational drug-prescribing behaviour. The current findings are promising for improving treatment policy in Tanzanian hospitals.
authors: Nijmegen Institute for International Health, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors: Guido J H
authors: GJ
authors: Bastiaens
authors: Erik
authors: E
authors: Schaftenaar
authors: Arnold
authors: A
authors: Ndaro
authors: Monique
authors: M
authors: Keuter
authors: Teun
authors: T
authors: Bousema
authors: Seif A
authors: SA
authors: Shekalaghe
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D003955:Diagnostic Tests, Routine; D011307:Drug Prescriptions; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006801:Humans; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D011446:Prospective Studies; D013636:Tanzania / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D000962:Antimalarials