October 14, 2010
A recent study (PLoS Medicine) returned some encouraging results regarding Rapid Diagnostic Tests (RDTs) and management of pneumonia and malaria in children in Zambia. We, here at CDDEP, have written about RDTs in the past, both on their potential to promote better treatment outcomes and make better use of limited treatment resources, and on the mixed evidence of their efficacy. RDTs could be a viable diagnostic option, but so far, their success has been limited by an inability to diagnose strains other than falciparum malaria, the difficulty in deploying them to the most-affected populations, and the tendency of health workers to disregard test results.
This study looked at managing RDTs through the informal sector in Zambia in an area where malaria, malnutrition, pneumonia, and diarrhea are the leading causes of death of children under the age of five. Specifically, the researchers examined how Community Health Workers (CHWs) and community case management may play an important role in maximizing the use of RDTs in diagnosing malaria and pneumonia (both diseases cause fever). CHWs were supplied with an ACT (artemether-lumefantrine, AL) and amoxicillin. After training CHWs in diagnosis, use of RDTs, and drug management, the study then looked at treatments and outcomes among children under the age of five who visited the clinic. The study’s conclusion is that the use of RDTs resulted in a significant increase in the proportion of appropriately timed antibiotic treatments for non-severe pneumonia and a significant decrease in the inappropriate use of antimalarials.
Both findings are important. Appropriate antibiotic use against non-severe pneumonia increases the likelihood of positive treatment outcomes. Inappropriate use of antimalarials is wasteful and costly, and it speeds the development of drug resistance. Decreasing inappropriate use of antimalarials means that limited resources will be used where they are most likely to have good outcomes and that effective ACTs will have a longer lifespan. The study found that prescribing treatments on the basis of RDT results led to a 4-fold reduction in the use of AL and that RDT use could substantially reduce the inappropriate use of antimalarials if prescribers adhere to the RDT results (which may be substantial as per the results of other studies).
More research into RDT use is warranted; so is research into other strategies to delay antimalarial resistance, such as the implementation of multiple first-line therapies (MFTs). There is evidence to support that MFTs can slow the spread of resistance and preserve the effectiveness of our most potent drugs.
Image Credit: Flickr: Eric Fortin