Malaria Diagnostic Testing and Treatment Practices in Three Different Plasmodium Falciparum Transmission Settings in Tanzania: Before and After a Government Policy Change

Overview

Journal Malar J

Publisher Biomed Central

Specialty Tropical Medicine

Date 2011 Apr 5

PMID 21457570

Citations 34

Authors

Guido J H Bastiaens

Erik Schaftenaar

Arnold Ndaro

Monique Keuter

Teun Bousema

Seif A Shekalaghe

Affiliations

Soon will be listed here.

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.

Conclusion: 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.

Citing Articles

Modeling pediatric antibiotic use in an area of declining malaria prevalence.

Rautman L, Eibach D, Boateng F, Akenten C, Hanson H, Maiga-Ascofare O Sci Rep. 2024; 14(1):16431.

PMID: 39014068 PMC: 11252319. DOI: 10.1038/s41598-024-67492-x.

Trends in health workers' compliance with outpatient malaria case-management guidelines across malaria epidemiological zones in Kenya, 2010-2016.

Amboko B, Stepniewska K, Macharia P, Machini B, Bejon P, Snow R Malar J. 2020; 19(1):406.

PMID: 33176783 PMC: 7659071. DOI: 10.1186/s12936-020-03479-z.

Impact of Insecticide Resistance on Vectors' Biting, Feeding, and Resting Behaviour in Selected Clusters in Teso North and South Subcounties in Busia County, Western Kenya.

Githinji E, Irungu L, Ndegwa P, Machani M, Amito R, Kemei B J Parasitol Res. 2020; 2020:9423682.

PMID: 32328298 PMC: 7168709. DOI: 10.1155/2020/9423682.

Government policy interventions to reduce human antimicrobial use: A systematic review and evidence map.

Rogers Van Katwyk S, Grimshaw J, Nkangu M, Nagi R, Mendelson M, Taljaard M PLoS Med. 2019; 16(6):e1002819.

PMID: 31185011 PMC: 6559631. DOI: 10.1371/journal.pmed.1002819.

Appropriateness of malaria diagnosis and treatment for fever episodes according to patient history and anti-malarial blood measurement: a cross-sectional survey from Tanzania.

Gallay J, Mosha D, Lutahakana E, Mazuguni F, Zuakulu M, Decosterd L Malar J. 2018; 17(1):209.

PMID: 29784001 PMC: 5963060. DOI: 10.1186/s12936-018-2357-7.

References

Greenwood B, Bojang K, Whitty C, Targett G . Malaria. Lancet. 2005; 365(9469):1487-98. DOI: 10.1016/S0140-6736(05)66420-3. View

Lubell Y, Reyburn H, Mbakilwa H, Mwangi R, Chonya K, Whitty C . The cost-effectiveness of parasitologic diagnosis for malaria-suspected patients in an era of combination therapy. Am J Trop Med Hyg. 2008; 77(6 Suppl):128-32. View

Guerra C, Gikandi P, Tatem A, Noor A, Smith D, Hay S . The limits and intensity of Plasmodium falciparum transmission: implications for malaria control and elimination worldwide. PLoS Med. 2008; 5(2):e38. PMC: 2253602. DOI: 10.1371/journal.pmed.0050038. View

Zurovac D, Midia B, Ochola S, English M, Snow R . Microscopy and outpatient malaria case management among older children and adults in Kenya. Trop Med Int Health. 2006; 11(4):432-40. DOI: 10.1111/j.1365-3156.2006.01587.x. View

Cook J, Reid H, Iavro J, Kuwahata M, Taleo G, Clements A . Using serological measures to monitor changes in malaria transmission in Vanuatu. Malar J. 2010; 9:169. PMC: 2904786. DOI: 10.1186/1475-2875-9-169. View

Gosling R, Drakeley C, Mwita A, Chandramohan D . Presumptive treatment of fever cases as malaria: help or hindrance for malaria control?. Malar J. 2008; 7:132. PMC: 2488354. DOI: 10.1186/1475-2875-7-132. View

Drakeley C, Corran P, Coleman P, Tongren J, McDonald S, Carneiro I . Estimating medium- and long-term trends in malaria transmission by using serological markers of malaria exposure. Proc Natl Acad Sci U S A. 2005; 102(14):5108-13. PMC: 555970. DOI: 10.1073/pnas.0408725102. View

Drakeley C, Carneiro I, Reyburn H, Malima R, Lusingu J, Cox J . Altitude-dependent and -independent variations in Plasmodium falciparum prevalence in northeastern Tanzania. J Infect Dis. 2005; 191(10):1589-98. DOI: 10.1086/429669. View

Barnish G, Bates I, Iboro J . Newer drug combinations for malaria. BMJ. 2004; 328(7455):1511-2. PMC: 437132. DOI: 10.1136/bmj.328.7455.1511. View

10.

Alifrangis M, Lusingu J, Mmbando B, Dalgaard M, Vestergaard L, Ishengoma D . Five-year surveillance of molecular markers of Plasmodium falciparum antimalarial drug resistance in Korogwe District, Tanzania: accumulation of the 581G mutation in the P. falciparum dihydropteroate synthase gene. Am J Trop Med Hyg. 2009; 80(4):523-7. View

11.

Wongsrichanalai C, Barcus M, Muth S, Sutamihardja A, Wernsdorfer W . A review of malaria diagnostic tools: microscopy and rapid diagnostic test (RDT). Am J Trop Med Hyg. 2008; 77(6 Suppl):119-27. View

12.

Mugittu K, Abdulla S, Falk N, Masanja H, Felger I, Mshinda H . Efficacy of sulfadoxine-pyrimethamine in Tanzania after two years as first-line drug for uncomplicated malaria: assessment protocol and implication for treatment policy strategies. Malar J. 2005; 4:55. PMC: 1315332. DOI: 10.1186/1475-2875-4-55. View

13.

Jambou R, Legrand E, Niang M, Khim N, Lim P, Volney B . Resistance of Plasmodium falciparum field isolates to in-vitro artemether and point mutations of the SERCA-type PfATPase6. Lancet. 2005; 366(9501):1960-3. DOI: 10.1016/S0140-6736(05)67787-2. View

14.

Ceesay S, Casals-Pascual C, Erskine J, Anya S, Duah N, Fulford A . Changes in malaria indices between 1999 and 2007 in The Gambia: a retrospective analysis. Lancet. 2008; 372(9649):1545-54. PMC: 2607025. DOI: 10.1016/S0140-6736(08)61654-2. View

15.

Amexo M, Tolhurst R, Barnish G, Bates I . Malaria misdiagnosis: effects on the poor and vulnerable. Lancet. 2004; 364(9448):1896-8. DOI: 10.1016/S0140-6736(04)17446-1. View

16.

Barat L, Chipipa J, Kolczak M, Sukwa T . Does the availability of blood slide microscopy for malaria at health centers improve the management of persons with fever in Zambia?. Am J Trop Med Hyg. 1999; 60(6):1024-30. DOI: 10.4269/ajtmh.1999.60.1024. View

17.

Sinclair D, Zani B, Donegan S, Olliaro P, Garner P . Artemisinin-based combination therapy for treating uncomplicated malaria. Cochrane Database Syst Rev. 2009; (3):CD007483. PMC: 6532584. DOI: 10.1002/14651858.CD007483.pub2. View

18.

Mwanziva C, Shekalaghe S, Ndaro A, Mengerink B, Megiroo S, Mosha F . Overuse of artemisinin-combination therapy in Mto wa Mbu (river of mosquitoes), an area misinterpreted as high endemic for malaria. Malar J. 2008; 7:232. PMC: 2588630. DOI: 10.1186/1475-2875-7-232. View

19.

Okiro E, Hay S, Gikandi P, Sharif S, Noor A, Peshu N . The decline in paediatric malaria admissions on the coast of Kenya. Malar J. 2007; 6:151. PMC: 2194691. DOI: 10.1186/1475-2875-6-151. View

20.

Stewart L, Gosling R, Griffin J, Gesase S, Campo J, Hashim R . Rapid assessment of malaria transmission using age-specific sero-conversion rates. PLoS One. 2009; 4(6):e6083. PMC: 2698122. DOI: 10.1371/journal.pone.0006083. View