Getting antimalarials on target: impact of national roll-out of malaria rapid diagnostic tests on health facility treatment in three regions of Tanzania.
OBJECTIVE
Parasitological confirmation of malaria prior to treatment is recommended for patients of all ages, with malaria rapid diagnostic tests (mRDTs) an important tool to target artemisinin-based combination therapies (ACTs) to patients with malaria. To evaluate the impact on case management practices of routine government implementation of mRDTs, we conducted large-scale health facility surveys in three regions of Tanzania before and after mRDT roll-out.


METHODS
Febrile patients at randomly selected health facilities were interviewed about care received at the facility, and blood samples were collected for reference blood smears. Health facility staff were interviewed about their qualifications and availability of malaria diagnostics and drugs.


RESULTS
The percentage of febrile patients tested for malaria at the facility increased from 15.8% in 2010 to 54.9% in 2012. ACTs were obtained by 65.8% of patients positive by reference blood smear in 2010 and by 50.2% in 2012 (P = 0.0675); no antimalarial was obtained by 57.8% of malaria-negative patients in 2010 and by 82.3% in 2012 (P < 0.0001). Overall, ACT use decreased (39.9-21.3%, P < 0.0001) and antibiotic use increased (31.2-48.5%, P < 0.0001).


CONCLUSIONS
Roll-out of mRDTs in Tanzania dramatically improved diagnostic testing for malaria and reduced overuse of ACTs for patients without parasitemia. However, post-roll-out almost 50% of febrile patients did not receive a diagnostic test, and almost 50% of patients testing positive did not receive ACTs. Stock-outs of ACTs and mRDTs were important problems. Further investigation is needed to determine reasons for not providing ACTs to patients with malaria and potential for inappropriate antibiotic use.
London School of Hygiene and Tropical Medicine, London, UK; Ifakara Health Institute, Dar es Salaam, Tanzania.
Katia
K
Bruxvoort
Admirabilis
A
Kalolella
Happy
H
Nchimbi
Charles
C
Festo
Mark
M
Taylor
Rebecca
R
Thomson
Matthew
M
Cairns
Julie
J
Thwing
Immo
I
Kleinschmidt
Catherine
C
Goodman
S Patrick
SP
Kachur
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000379:methods* / Q000592:standards; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D018512:Parasitemia / Q000188:drug therapy*; D013636:Tanzania; D055815:Young Adult
D000962:Antimalarials
Tanzania; antibiotic use; artemisinin-based combination therapie; drug stock-outs; implementation; malaria; malaria rapid diagnostic test