Effect of Malaria Rapid Diagnostic Tests on the Management of Uncomplicated Malaria with Artemether-Lumefantrine in Kenya: A Cluster Randomized Trial

Jacek Skarbinski Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Kenya, Nairobi, Kenya; Department of International Health, School of Public Health, Boston University, Boston, Massachusetts; KEMRI/CDC Field Research Station, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Kenya, Nairobi, Kenya

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Peter O. Ouma Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Kenya, Nairobi, Kenya; Department of International Health, School of Public Health, Boston University, Boston, Massachusetts; KEMRI/CDC Field Research Station, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Kenya, Nairobi, Kenya

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Louise M. Causer Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Kenya, Nairobi, Kenya; Department of International Health, School of Public Health, Boston University, Boston, Massachusetts; KEMRI/CDC Field Research Station, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Kenya, Nairobi, Kenya

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Simon K. Kariuki Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Kenya, Nairobi, Kenya; Department of International Health, School of Public Health, Boston University, Boston, Massachusetts; KEMRI/CDC Field Research Station, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Kenya, Nairobi, Kenya

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John W. Barnwell Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Kenya, Nairobi, Kenya; Department of International Health, School of Public Health, Boston University, Boston, Massachusetts; KEMRI/CDC Field Research Station, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Kenya, Nairobi, Kenya

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Jane A. Alaii Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Kenya, Nairobi, Kenya; Department of International Health, School of Public Health, Boston University, Boston, Massachusetts; KEMRI/CDC Field Research Station, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Kenya, Nairobi, Kenya

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Alexandre Macedo de Oliveira Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Kenya, Nairobi, Kenya; Department of International Health, School of Public Health, Boston University, Boston, Massachusetts; KEMRI/CDC Field Research Station, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Kenya, Nairobi, Kenya

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Dejan Zurovac Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Kenya, Nairobi, Kenya; Department of International Health, School of Public Health, Boston University, Boston, Massachusetts; KEMRI/CDC Field Research Station, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Kenya, Nairobi, Kenya

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Bruce A. Larson Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Kenya, Nairobi, Kenya; Department of International Health, School of Public Health, Boston University, Boston, Massachusetts; KEMRI/CDC Field Research Station, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Kenya, Nairobi, Kenya

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Robert W. Snow Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Kenya, Nairobi, Kenya; Department of International Health, School of Public Health, Boston University, Boston, Massachusetts; KEMRI/CDC Field Research Station, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Kenya, Nairobi, Kenya

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Alexander K. Rowe Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Kenya, Nairobi, Kenya; Department of International Health, School of Public Health, Boston University, Boston, Massachusetts; KEMRI/CDC Field Research Station, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Kenya, Nairobi, Kenya

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Kayla F. Laserson Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Kenya, Nairobi, Kenya; Department of International Health, School of Public Health, Boston University, Boston, Massachusetts; KEMRI/CDC Field Research Station, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Kenya, Nairobi, Kenya

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Willis S. Akhwale Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Kenya, Nairobi, Kenya; Department of International Health, School of Public Health, Boston University, Boston, Massachusetts; KEMRI/CDC Field Research Station, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Kenya, Nairobi, Kenya

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Laurence Slutsker Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Kenya, Nairobi, Kenya; Department of International Health, School of Public Health, Boston University, Boston, Massachusetts; KEMRI/CDC Field Research Station, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Kenya, Nairobi, Kenya

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Mary J. Hamel Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Kenya, Nairobi, Kenya; Department of International Health, School of Public Health, Boston University, Boston, Massachusetts; KEMRI/CDC Field Research Station, Kisumu, Kenya; Division of Malaria Control, Ministry of Health, Kenya, Nairobi, Kenya

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DOI:
https://doi.org/10.4269/ajtmh.2009.80.919
Volume/Issue:
Volume 80: Issue 6
Page(s):
919–926
Restricted access
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Shortly after Kenya introduced artemether-lumefantrine (AL) for first-line treatment of uncomplicated malaria, we conducted a pre-post cluster randomized controlled trial to assess the effect of providing malaria rapid diagnostic tests (RDTs) on recommended treatment (patients with malaria prescribed AL) and overtreatment (patients without malaria prescribed AL) in outpatients ≥ 5 years old. Sixty health facilities were randomized to receive either RDTs plus training, guidelines, and supervision (TGS) or TGS alone. Of 1,540 patients included in the analysis, 7% had uncomplicated malaria. The provision of RDTs coupled with TGS emphasizing AL use only after laboratory confirmation of malaria reduced recommended treatment by 63%-points (P = 0.04), because diagnostic test use did not change (−2%-points), but health workers significantly reduced presumptive treatment with AL for patients with a clinical diagnosis of malaria who did not undergo testing (−36%-points; P = 0.03). Health workers generally adhered to RDT results when prescribing AL: 88% of RDT-positive and 9% of RDT-negative patients were treated with AL, respectively. Overtreatment was low in both arms and was not significantly reduced by the provision of RDTs (−12%-points, P = 0.30). RDTs could potentially improve malaria case management, but we urgently need to develop more effective strategies for implementing guidelines before large scale implementation.

Author Notes

Reprint requests: Jacek Skarbinski, Malaria Branch, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341-3724, Tel: 770-488-7741, Fax: 770-488-4206, E-mail: jskarbinski@cdc.gov.
Copyright:
Copyright 2009 The American Society of Tropical Medicine 2009
Received:
06 Dec 2008
|
Accepted:
22 Mar 2009
|
Published Online:
Jun 2009
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
  • 1

    World Health Organization, 2006. Guidelines for the Treatment of Malaria. Geneva, World Health Organization.

    • PubMed
    • Export Citation
  • 2

    Chandramohan D, Jaffar S, Greenwood B, 2002. Use of clinical algorithms for diagnosing malaria. Trop Med Int Health 7 :45–52.

  • 3

    Kallander K, Nsungwa-Sabiiti J, Peterson S, 2004. Symptom overlap for malaria and pneumonia—policy implications for home management strategies. Acta Trop 90 :211–214.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Mwangi TW, Mohammed M, Dayo H, Snow RW, Marsh K, 2005. Clinical algorithms for malaria diagnosis lack utility among people of different age groups. Trop Med Int Health 10 :530–536.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Amexo M, Tolhurst R, Barnish G, Bates I, 2004. Malaria misdiagnosis: effects on the poor and vulnerable. Lancet 364 :1896–1898.

  • 6

    Barat L, Chipipa J, Kolczak M, Sukwa T, 1999. 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 60 :1024–1030.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Makani J, Matuja W, Liyombo E, Snow RW, Marsh K, Warrell DA, 2003. Admission diagnosis of cerebral malaria in adults in an endemic area of Tanzania: implications and clinical description. QJM 96 :355–362.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Zurovac D, Midia B, Ochola SA, English M, Snow RW, 2006. Microscopy and outpatient malaria case management among older children and adults in Kenya. Trop Med Int Health 11 :432–440.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Reyburn H, Mbatia R, Drakeley C, Whitty CJ, 2004. Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study. BMJ 329 :1212.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    World Health Organization, 2009. Global Antimalarial Drug Policy Database - AFRO. Available at: http://www.who.int/malaria/amdp/amdp_afro.htm. Accessed April 24, 2009.

    • PubMed
    • Export Citation
  • 11

    Amin AA, Zurovac D, Kangwana BB, Greenfield J, Otieno DN, Akhwale WS, Snow RW, 2007. The challenges of changing national malaria drug policy to artemisinin-based combinations in Kenya. Malar J 6 :72.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Kenya Ministry of Health (MoH), 2006. National Guidelines for Diagnosis, Treatment, & Prevention of Malaria for Health Workers. Nairobi, Kenya: Republic of Kenya.

    • PubMed
    • Export Citation
  • 13

    Bell D, Wongsrichanalai C, Barnwell JW, 2006. Ensuring quality and access for malaria diagnosis: how can it be achieved? Nat Rev Microbiol 4 (Suppl):S7–S20.

  • 14

    World Health Organization, 2006. The Use of Malaria Rapid Diagnostic Tests. Second Edition. Geneva: World Health Organization.

    • PubMed
    • Export Citation
  • 15

    Moody A, 2002. Rapid diagnostic tests for malaria parasites. Clin Microbiol Rev 15 :66–78.

  • 16

    Murray CK, Bell D, Gasser RA, Wongsrichanalai C, 2003. Rapid diagnostic testing for malaria. Trop Med Int Health 8 :876–883.

  • 17

    Proux S, Hkirijareon L, Ngamngonkiri C, McConnell S, Nosten F, 2001. Paracheck-Pf: a new, inexpensive and reliable rapid test for P. falciparum malaria. Trop Med Int Health 6 :99–101.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Hopkins H, Kambale W, Kamya MR, Staedke SG, Dorsey G, Rosenthal PJ, 2007. Comparison of HRP2- and pLDH-based rapid diagnostic tests for malaria with longitudinal follow-up in Kampala, Uganda. Am J Trop Med Hyg 76 :1092–1097.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Mboera LE, Fanello CI, Malima RC, Talbert A, Fogliati P, Bobbio F, Molteni F, 2006. Comparison of the Paracheck-Pf test with microscopy, for the confirmation of Plasmodium falciparum malaria in Tanzania. Ann Trop Med Parasitol 100 :115–122.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Murray CK, Gasser RA Jr, Magill AJ, Miller RS, 2008. Update on rapid diagnostic testing for malaria. Clin Microbiol Rev 21 :97–110.

  • 21

    Wongsrichanalai C, Barcus MJ, Muth S, Sutamihardja A, Wernsdorfer WH, 2007. A review of malaria diagnostic tools: microscopy and rapid diagnostic test (RDT). Am J Trop Med Hyg 77 (Suppl):119–127.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Adazu K, Lindblade KA, Rosen DH, Odhiambo F, Ofware P, Kwach J, Van Eijk AM, Decock KM, Amornkul P, Karanja D, Vulule JM, Slutsker L, 2005. Health and demographic surveillance in rural western Kenya: a platform for evaluating interventions to reduce morbidity and mortality from infectious diseases. Am J Trop Med Hyg 73 :1151–1158.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Shanks GD, Hay SI, Omumbo JA, Snow RW, 2005. Malaria in Kenya’s western highlands. Emerg Infect Dis 11 :1425–1432.

  • 24

    Macedo de Oliveira AM, Skarbinski J, Ouma PO, Kariuki S, Barnwell JW, Otieno K, Onyona P, Causer LM, Laserson KF, Akhwale WS, Slutsker L, Hamel M, 2009. Malaria rapid diagnostic test performance as part of routine malaria case management in Kenya. Am J Trop Med Hyg 80 :470–474.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Font F, Alonso Gonzalez M, Nathan R, Kimario J, Lwilla F, Ascaso C, Tanner M, Menendez C, Alonso PL, 2001. Diagnostic accuracy and case management of clinical malaria in the primary health services of a rural area in south-eastern Tanzania. Trop Med Int Health 6 :423–428.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Reyburn H, Mbakilwa H, Mwangi R, Mwerinde O, Olomi R, Drakeley C, Whitty CJ, 2007. Rapid diagnostic tests compared with malaria microscopy for guiding outpatient treatment of febrile illness in Tanzania: randomised trial. BMJ 334 :403.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Reyburn H, Ruanda J, Mwerinde O, Drakeley C, 2006. The contribution of microscopy to targeting antimalarial treatment in a low transmission area of Tanzania. Malar J 5 :4.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Zurovac D, Ochola SA, Midia B, Snow RW, 2005. The quality of sulfadoxine-pyrimethamine prescriptions, counselling and drug-dispensing practices, for children in Kenya. Ann Trop Med Parasitol 99 :321–324.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Hamer DH, Ndhlovu M, Zurovac D, Fox M, Yeboah-Antwi K, Chanda P, Sipilinyambe N, Simon JL, Snow RW, 2007. Improved diagnostic testing and malaria treatment practices in Zambia. JAMA 297 :2227–2231.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Zurovac D, Ndhlovu M, Rowe AK, Hamer DH, Thea DM, Snow RW, 2005. Treatment of paediatric malaria during a period of drug transition to artemether-lumefantrine in Zambia: cross sectional study. BMJ 331 :734.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Zurovac D, Njogu J, Akhwale W, Hamer DH, Snow RW, 2008. Translation of artemether-lumefantrine treatment policy into paediatric clinical practice: an early experience from Kenya. Trop Med Int Health 13 :99–107.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Zurovac D, Ndhlovu M, Sipilanyambe N, Chanda P, Hamer DH, Simon JL, Snow RW, 2007. Paediatric malaria case-management with artemether-lumefantrine in Zambia: a repeat cross-sectional study. Malar J 6 :31.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Wasunna B, Zurovac D, Goodman CA, Snow RW, 2008. Why don’t health workers prescribe ACT? A qualitative study of factors affecting the prescription of artemether-lumefantrine. Malar J 7 :29.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Rowe SY, Olewe MA, Kleinbaum DG, McGowan JE, McFarland DA, Rochat R, Deming MS, 2006. The influence of observation and setting on community health workers’ practices. Int J Qual Health Care 18 :299–305.

    • PubMed
    • Search Google Scholar
    • Export Citation
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