Volume 83, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Rapid diagnostic tests (RDTs) were developed as an alternative to microscopy for malaria diagnosis. The RDTs detect malaria parasite antigen(s) in whole blood with high sensitivity and specificity. We assessed health worker malaria treatment practices after the introduction of RDTs in peripheral health facilities without microscopy. From December 2007 to October 2008, we introduced histidine-rich protein II (HRP-2)-based ParaHIT RDTs for routine use in 12 health facilities in Rufiji District, Tanzania. Health workers received training on how to perform RDTs for patients 5 years of age or older with fever or suspected malaria. Children < 5 years of age were to be treated empirically per national guidelines. Among the 30,195 patients seen at these 12 health facilities, 10,737 (35.6%) were tested with an RDT for malaria. 88.3% (9,405/10,648) of tested patients reported fever or history of fever and 2.7% (289/10,677) of all tested individuals were children < 5 years of age. The RDT results were recorded for 10,650 patients (99.2%). Among the 5,488 (51.5%) RDT-positive patients, 5,256 (98.6%) were treated with an appropriate first-line antimalarial per national guidelines (artemether-lumefantrine or quinine). Among the 5,162 RDT-negative patients, only 205 (4.0%) were treated with an antimalarial. Other reported treatments included antibiotics and antipyretics. Implementation of RDTs in rural health facilities resulted in high adherence to national treatment guidelines. Patients testing negative by RDT were rarely treated with antimalarials. Unapproved antimalarials were seldom used. Health workers continued to follow guidelines for the empiric treatment of febrile children.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Singer B, Teklahaimanot A, , 2003. Background Paper of the Millenium Project Task Force on Major Diseases and Access to Medicine, Subgroup on Malaria. New York: United Nations Development Program (UNDP). [Google Scholar]
  2. Reyburn H, Mbatia R, Drakeley C, Carneiro I, Mwakasungula E, Mwerinde O, Saganda K, Shao J, Kitua A, Olomi R, Greenwood MB, Whitty CJM, , 2004. Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study. BMJ 329: 1212.[Crossref] [Google Scholar]
  3. Moody A, , 2002. Rapid diagnostic tests for malaria parasites. Clin Microbiol Rev 15: 6678.[Crossref] [Google Scholar]
  4. Proux S, Hkirijareon L, Ngamngonkiri C, McConnel S, Nosten F, , 2001. Paracheck-Pf: a new, inexpensive and reliable rapid test for P. falciparum malaria. Trop Med Int Health 6: 99101.[Crossref] [Google Scholar]
  5. Reyburn H, Ruanda J, Mwerinde O, Drakeley C, , 2006. The contribution of microscopy to targeting antimalarial treatment in low transmission area of Tanzania. Malar J 5: 4.[Crossref] [Google Scholar]
  6. Reyburn H, Mbakilwa H, Mwangi R, Mwerinde O, Olomi R, Drakeley C, Whitty CJ, , 2007. Rapid diagnostic tests compare with malaria microscopy for guiding outpatient treatment of febrile illness in Tanzania: randomized trial. BMJ 334: 403.[Crossref] [Google Scholar]
  7. Makani J, Matuja W, Liyombo E, Snow RW, Marsh K, Warell DA, , 2003. Admission diagnosis of cerebral malaria in adults in an endemic area of Tanzania: implications and clinical description. Q J Med 96: 355362.[Crossref] [Google Scholar]
  8. Zurovac D, Njogu J, Akhwale W, Hamer DH, Larson BA, Snow RW, , 2008. Effects of revised diagnostic recommendations on malaria treatment across age groups in Kenya. Trop Med Int Health 13: 784787.[Crossref] [Google Scholar]
  9. Rufiji DSS, , 1999, Tanzania. Tanzania Ministry of Health and Tanzania Essential Health Interventions Project. INDEPTH Monograph: Volume 1 Part C. Available at: http://www.indepth-network.org/dss_site_profile/rufiji.pdf. Accessed March 15, 2010. [Google Scholar]
  10. McMorrow ML, Masanja MI, Kahigwa E, Abdulla SM, Kachur SP, , 2010. Quality assurance of rapid diagnostic tests for malaria in routine patient care in rural Tanzania. Am J Trop Med Hyg 82: 151155.[Crossref] [Google Scholar]
  11. World Health Organization, Guidelines for the Treatment of Malaria, Second edition. Available at: http://www.who.int/malaria/publications/atoz/9789241547925/en/index.html. Accessed March 15, 2010. [Google Scholar]
  12. World Health Organization, 2009. Malaria rapid diagnostic test performance: results of WHO product testing of malaria RDTs: round 1. Available at: http://www.finddiagnostics.org/export/sites/default/media/press/pdf/Full-report-malaria-RDTs.pdf. Accessed March 8, 2010. [Google Scholar]
  13. Kyabayinze DJ, Tibenderana JK, Odong GW, Rwakimari JB, Counihan H, , 2008. Operational accuracy and comparative persistent antigenicity of HRP2 rapid diagnostic tests for Plasmodium falciparum malaria in a hyperendemic region of Uganda. Malar J 7: 221.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 02 Apr 2010
  • Accepted : 31 Aug 2010
  • Published online : 06 Dec 2010

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error