title: Malaria rapid testing by community health workers is effective and safe for targeting malaria treatment: randomised cross-over trial in Tanzania.
abstract: BACKGROUND
  Early diagnosis and prompt, effective treatment of uncomplicated malaria is critical to prevent severe disease, death and malaria transmission. We assessed the impact of rapid malaria diagnostic tests (RDTs) by community health workers (CHWs) on provision of artemisinin-based combination therapy (ACT) and health outcome in fever patients.
  
  
  RESULTS
  Twenty-two CHWs from five villages in Kibaha District, a high-malaria transmission area in Coast Region, Tanzania, were trained to manage uncomplicated malaria using RDT aided diagnosis or clinical diagnosis (CD) only. Each CHW was randomly assigned to use either RDT or CD the first week and thereafter alternating weekly. Primary outcome was provision of ACT and main secondary outcomes were referral rates and health status by days 3 and 7. The CHWs enrolled 2930 fever patients during five months of whom 1988 (67.8%) presented within 24 hours of fever onset. ACT was provided to 775 of 1457 (53.2%) patients during RDT weeks and to 1422 of 1473 (96.5%) patients during CD weeks (Odds Ratio (OR) 0.039, 95% CI 0.029-0.053). The CHWs adhered to the RDT results in 1411 of 1457 (96.8%, 95% CI 95.8-97.6) patients. More patients were referred on inclusion day during RDT weeks (10.0%) compared to CD weeks (1.6%). Referral during days 1-7 and perceived non-recovery on days 3 and 7 were also more common after RDT aided diagnosis. However, no fatal or severe malaria occurred among 682 patients in the RDT group who were not treated with ACT, supporting the safety of withholding ACT to RDT negative patients.
  
  
  CONCLUSIONS
  RDTs in the hands of CHWs may safely improve early and well-targeted ACT treatment in malaria patients at community level in Africa.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00301015.
authors.affiliation: Department of Parasitology, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Marycelina
authors.initials: M
authors.lastname: Mubi
authors.forename: Annika
authors.initials: A
authors.lastname: Janson
authors.forename: Marian
authors.initials: M
authors.lastname: Warsame
authors.forename: Andreas
authors.initials: A
authors.lastname: Mårtensson
authors.forename: Karin
authors.initials: K
authors.lastname: Källander
authors.forename: Max G
authors.initials: MG
authors.lastname: Petzold
authors.forename: Billy
authors.initials: B
authors.lastname: Ngasala
authors.forename: Gloria
authors.initials: G
authors.lastname: Maganga
authors.forename: Lars L
authors.initials: LL
authors.lastname: Gustafsson
authors.forename: Amos
authors.initials: A
authors.lastname: Massele
authors.forename: Göran
authors.initials: G
authors.lastname: Tomson
authors.forename: Zul
authors.initials: Z
authors.lastname: Premji
authors.forename: Anders
authors.initials: A
authors.lastname: Björkman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000592:standards / Q000706:statistics & numerical data; D003150:Community Health Workers / Q000592:standards / Q000706:statistics & numerical data*; D018592:Cross-Over Studies; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000592:standards; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000209:etiology; D006282:Health Personnel / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008288:Malaria / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D013636:Tanzania
chemical_list: D000962:Antimalarials; D037621:Artemisinins; C031327:artemisinin