title: Integrated community case management of fever in children under five using rapid diagnostic tests and respiratory rate counting: a multi-country cluster randomized trial.
abstract: Evidence on the impact of using diagnostic tests in community case management of febrile children is limited. This effectiveness trial conducted in Burkina Faso, Ghana, and Uganda, compared a diagnostic and treatment package for malaria and pneumonia with presumptive treatment with anti-malarial drugs; artemisinin combination therapy (ACT). We enrolled 4,216 febrile children between 4 and 59 months of age in 2009-2010. Compliance with the malaria rapid diagnostic test (RDT) results was high in the intervention arm across the three countries, with only 4.9% (17 of 344) of RDT-negative children prescribed an ACT. Antibiotic overuse was more common: 0.9% (4 of 446) in Uganda, 38.5% (114 of 296) in Burkina Faso, and 44.6% (197 of 442) in Ghana. Fever clearance was high in both intervention and control arms at both Day 3 (97.8% versus 96.9%, P = 0.17) and Day 7 (99.2% versus 98.8%, P = 0.17). The use of diagnostic tests limits overuse of ACTs. Its impact on antibiotic overuse and on fever clearance is uncertain.
authors.forename: David
authors.initials: D
authors.lastname: Mukanga
authors.forename: Alfred B
authors.initials: AB
authors.lastname: Tiono
authors.forename: Thomas
authors.initials: T
authors.lastname: Anyorigiya
authors.forename: Karin
authors.initials: K
authors.lastname: Källander
authors.forename: Amadou T
authors.initials: AT
authors.lastname: Konaté
authors.forename: Abraham R
authors.initials: AR
authors.lastname: Oduro
authors.forename: James K
authors.initials: JK
authors.lastname: Tibenderana
authors.forename: Lucas
authors.initials: L
authors.lastname: Amenga-Etego
authors.forename: Sodiomon B
authors.initials: SB
authors.lastname: Sirima
authors.forename: Simon
authors.initials: S
authors.lastname: Cousens
authors.forename: Guy
authors.initials: G
authors.lastname: Barnish
authors.forename: Franco
authors.initials: F
authors.lastname: Pagnoni
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use; D037621:Artemisinins / Q000627:therapeutic use; D002050:Burkina Faso; D019090:Case Management; D002675:Child, Preschool; D016000:Cluster Analysis; D003153:Community Health Services; D003955:Diagnostic Tests, Routine / Q000379:methods*; D019468:Disease Management; D005260:Female; D005334:Fever / Q000175:diagnosis* / Q000188:drug therapy; D005869:Ghana; D006801:Humans; D057970:Inappropriate Prescribing; D007223:Infant; D008288:Malaria / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy; D056152:Respiratory Rate; D016896:Treatment Outcome; D014454:Uganda
chemical_list: D000900:Anti-Bacterial Agents; D000962:Antimalarials; D037621:Artemisinins; C031327:artemisinin