round up of recent abstracts on RDTs from pubmed ...
malaria updates at: https://twitter.com/#!/bbbrieger and http://malariamatters.org/ and http://knowledge-gateway.org/malariahttps://www.coursera.org/course/communitychange; https://www.coursera.org/course/commhealthworkers
|1.||Malar J. 2013 Jul 22;12:258. doi: 10.1186/1475-2875-12-258.|
"Even if the test result is negative, they should be able to tell us what is wrong with us": a qualitative study of patient expectations of rapid diagnostic tests for malaria.Ansah EK, Reynolds J, Akanpigbiam S, Whitty CJ, Chandler CI.
Dangme West District Health Directorate, Ghana Health Service, PO Box DD1, Dodowa, Ghana. Ansahekdr@yahoo.co.uk.
The debate on rapid diagnostic tests (RDTs) for malaria has begun to shift from whether RDTs should be used, to how and under what circumstances their use can be optimized. This has increased the need for a better understanding of the complexities surrounding the role of RDTs in appropriate treatment of fever. Studies have focused on clinician practices, but few have sought to understand patient perspectives, beyond notions of acceptability.
This qualitative study aimed to explore patient and caregiver perceptions and experiences of RDTs following a trial to assess the introduction of the tests into routine clinical care at four health facilities in one district in Ghana. Six focus group discussions and one in-depth interview were carried out with those who had received an RDT with a negative test result.
Patients had high expectations of RDTs. They welcomed the tests as aiding clinical diagnoses and as tools that could communicate their problem better than they could, verbally. However, respondents also believed the tests could identify any cause of illness, beyond malaria. Experiences of patients suggested that RDTs were adopted into an existing system where patients are both physically and intellectually removed from diagnostic processes and where clinicians retain authority that supersedes tests and their results. In this situation, patients did not feel able to articulate a demand for test-driven diagnosis.
Improvements in communication between the health worker and patient, particularly to explain the capabilities of the test and management of RDT negative cases, may both manage patient expectations and promote patient demand for test-driven diagnoses.
|PMID: 23876112 [PubMed - in process]|
|2.||Case Rep Med. 2013;2013:465906. doi: 10.1155/2013/465906. Epub 2013 Jun 19.|
Irregular Migration as a Potential Source of Malaria Reintroduction in Sri Lanka and Use of Malaria Rapid Diagnostic Tests at Point-of-Entry Screening.Wickramage K, Galappaththy GN, Dayarathne D, Peiris SL, Basnayake RN, Mosca D, Jacobs J.
Health Unit, International Organization for Migration (IOM), No. 62, Green Path, Ananda Coomaraswamy Road, 3 Colombo, Sri Lanka.
Background. We describe an irregular migrant who returned to Sri Lanka after a failed people smuggling operation from West Africa. Results. On-arrival screening by Anti-Malaria Campaign (AMC) officers using a rapid diagnostic test (RDT) (CareStart Malaria HRP2/PLDH) indicated a negative result. On day 3 after arrival, he presented with fever and chills but was managed as dengue (which is hyperendemic in Sri Lanka). Only on day 7, diagnosis of Plasmodium falciparum malaria was made by microcopy and CareStart RDT. The initially negative RDT was ascribed to a low parasite density. Irregular migration may be an unrecognized source of malaria reintroduction. Despite some limitations in detection, RDTs form an important point-of-entry assessment. As a consequence of this case, the AMC is now focused on repeat testing and close monitoring of all irregular migrants from malaria-endemic zones. Conclusion. The present case study highlights the effective collaboration and coordination between inter-governmental agencies such as IOM and the Ministry of Health towards the goals of malaria elimination in Sri Lanka.
|PMID: 23861687 [PubMed]|
|3.||Malar J. 2013 Jul 12;12:240. doi: 10.1186/1475-2875-12-240.|
Community case management in malaria: review and perspectives after four years of operational experience in Saraya district, south-east Senegal.Ndiaye Y, Ndiaye JL, Cisse B, Blanas D, Bassene J, Manga IA, Ndiath M, Faye SL, Bocoum M, Ndiaye M, Thior PM , Sene D, Milligan P, Gaye O, Schellenberg D.
Ministry of Health and Social Action, Dakar, Senegal. firstname.lastname@example.org.
Despite recent advances in malaria diagnosis and treatment, many isolated communities in rural settings continue to lack access to these life-saving tools. Community-case management of malaria (CCMm), consisting of lay health workers (LHWs) using malaria rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT) in their villages, can address this disparity.
This study examined routine reporting data from a CCMm programme between 2008 and 2011 in Saraya, a rural district in Senegal, and assessed its impact on timely access to rapid diagnostic tests and ACT.
There was a seven-fold increase in the number of LHWs providing care and in the number of patients seen. LHW engagement in the CCM programme varied seasonally, 24,3% of all patients prescribed an ACT had a negative RDT or were never administered an RDT, and less than half of patients with absolute indications for referral (severe symptoms, age under two months and pregnancy) were referred. There were few stock-outs.
This CCMm programme successfully increased the number of patients with access to RDT and ACT, but further investigation is required to identify the cause for over-prescription, and low rates of referrals for patients with absolute indications. In contrast, previous widespread stock-outs in Saraya's CCMm programme have now been resolved.
This study demonstrates the potential for CCMm programmes to substantially increase access to life-saving malarial diagnostics and treatment, but also highlights important challenges in ensuring quality.
|PMID: 23849053 [PubMed - in process]|