When offered, many will take malaria rapid test, cutting misuse of drugs, study finds

Malaria rapid diagnostic test. (Credit: Novartis AG/flickr)

A study published yesterday in PLOS ONE says testing people for malaria helps reduce the over-prescription of anti-malarial drugs by 73 percent. Knowing whether a person actually has malaria means people get the medicine they need.

What is notable about the new research is that malaria cases were determined using rapid diagnostic tests at registered drug shops. Rather than waiting for blood tests under microscopes at health clinics, people with suspected cases of malaria can get their results immediately and purchase the drugs that will eliminate the parasite.

“Our findings show that it is feasible to collaborate with the private health sector and introduce malaria rapid diagnostic tests in drug shops. The next step is to refine the strategy and understand the cost implications of scaling it up,” said lead author, professor Anthony Mbonye from the Ugandan Ministry of Health, in a release.

Drug shops in the Mukono district of central Uganda were randomly placed into groups where the tests were and were not offered to patients. In the shops with the tests, patients had the option to buy one when experiencing a fever. More than 15,000 people sought treatment for fevers at the clinics. Some 97.8 percent of the patients going to the rapid diagnostic test shops choose to buy the test.

The researchers also collected and evaluated blood samples of patients to verify who actually had malaria. As one would expect, testing patients for malaria greatly reduced the chance of mistreatment. Mbonye and his fellow researchers are optimistic that the study can help the World Health Organization engage with private drug providers in an effort to reduce misuse of anti-malaria drugs.

Artemisinin-based Combination Therapy is one of the best treatments for people with malaria. It is extremely effective against multi-drug resistant forms, but there is evidence of emerging resistance in the border region between Cambodia and Vietnam. The World Health Organization drew attention to the problem in the past few years with the hopes that resistance will not progress and spread to other parts of the world.

And the ramifications of the research goes beyond malaria. Private health clinics are often on the front lines for dealing with a wide array of health issues in developing countries. Thinking of ways that governments and international bodies can support these businesses is important to public health.

“This study shows that rapid diagnostic tests can improve the use of artemisinin-based combination therapies – the most effective treatment for malaria – in drug shops, but it’s not without its challenges,” said Dr Sian Clarke from the London School of Hygiene & Tropical Medicine, also a principal investigator in the research, in a release. “These tests alone will not improve the treatment of other diseases. We now need to continue working with the Ministry of Health to investigate how to improve our approach and expand it to other common illnesses.”

But it all comes with an important warning. Allowing drug shop owners to use rapid diagnostic tests helps better determine malaria cases, and it also inflates the feeling that the untrained owners can act as health workers. Research conducted alongside the trial found that the tests help make the private drug shops more legitimate. That concerns trained health workers who feel it may undercut their authority and expertise.

“For those wishing to introduce these medically and socially powerful diagnostics into these spaces at the margins of the health system, the regulation of these shops will become imperative and they will need to find a position for drug shop vendors within the hierarchies of the formal system,” said the authors.

How to go about enacting such regulations and oversight will be evaluated in future trials.

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Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]humanosphere.org.