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Rapid Diagnostic Testing for Malaria Reduces Overprescribing in Uganda

The introduction of rapid diagnostic tests for malaria in registered drug shops improved treatment of the disease in Uganda, according to the results of a randomized trial.

Rapid diagnostic tests for malaria (mRDTs) were established in 20 geographical clusters of registered drug shops in Uganda’s Mukono district. A cluster was defined as a grouping of one or more registered drug shops within one administrative area.

The researchers randomly assigned 10 clusters to the intervention arm, consisting of the diagnostic confirmation of malaria using mRDT followed by artemisinin-based combination therapy (ACT). In the 10 clusters assigned to the control arm, febrile patients were treated presumptively with ACT.

From January 2011 to December 2011, 15,517 eligible patients with fever sought treatment from one of the 59 registered drug shops enrolled in the study, according to the researchers. Drug shop staff were trained in appropriate malaria diagnosis and treatment, and staff in the control arm were trained how to presumptively diagnose malaria.

Most febrile patients (97.8%) purchased an mRDT from a drug shop; 58.5% had positive test results. The researchers verified that 95% of these readings were accurate.

The majority of drug shop vendors adhered to the test results; only 49 (1.5%) of mRDT-negative patients were referred to ACT, according to the researchers.

Overall, mRDT testing helped substantially reduce antimalarial prescriptions. Of the patients in the mRDT test group, 62.5% received ACT vs. 99.8% in the presumptive diagnosis arm, the researchers wrote. With mRDT, overprescription of malaria drugs was reduced by 72.6%.

“Our findings show that it is feasible to collaborate with the private health sector and introduce malaria rapid diagnostic tests in drug shops,” study researcher Anthony K. Mbonye, PhD, commissioner of health services at the Ugandan Ministry of Health, said in a press release. “The next step is to refine the strategy and understand the cost implications of scaling it up in Uganda. Our long-term aim is to provide evidence to help [WHO] develop guidance to improve malaria treatment in the private sector.”

Source: Healio

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