Research Summary: Major Reduction in Anti-Malarial Drug Consumption in Senegal after Nation-Wide Introduction of Malaria Rapid Diagnostic Tests



While WHO recently recommended universal parasitological confirmation of
suspected malaria prior to treatment, debate has continued as to whether
wide-scale use of rapid diagnostic tests (RDTs) can achieve this goal.
Adherence of health service personnel to RDT results has been poor in some
settings, with little impact on anti-malarial drug consumption. The Senegal
national malaria control programme introduced universal parasite-based
diagnosis using malaria RDTs from late 2007 in all public health facilities.
This paper assesses the impact of this programme on anti-malarial drug
consumption and disease reporting.

Methods and Findings

Nationally-collated programme data from 2007 to 2009 including malaria
diagnostic outcomes, prescription of artemisinin-based combination therapy
(ACT) and consumption of RDTs in public health facilities, were reviewed and
compared. Against a marked seasonal variation in all-cause out-patient
visits, non-malarial fever and confirmed malaria, parasite-based diagnosis
increased nationally from 3.9% of reported malaria-like febrile
illness to 86.0% over a 3 year period. The prescription of ACT
dropped throughout this period from 72.9% of malaria-like febrile
illness to 31.5%, reaching close equivalence to confirmed malaria
(29.9% of 584873 suspect fever cases). An estimated 516576 courses of
inappropriate ACT prescription were averted.


The data indicate high adherence of anti-malarial prescribing practice to RDT
results after an initial run-in period. The large reduction in ACT
consumption enabled by the move from symptom-based to parasite-based
diagnosis demonstrates that effective roll-out and use of malaria RDTs is
achievable on a national scale through well planned and structured
implementation. While more detailed information on management of
parasite-negative cases is required at point of care level to assess overall
cost-benefits to the health sector, considerable cost-savings were achieved
in ACT procurement. Programmes need to be allowed flexibility in management
of these funds to address increases in other programmatic costs that may
accrue from improved diagnosis of febrile disease.


Publisher: Public Library of Science

Date Published: 6-April-2011

Author(s): Thiam S., Thior M., Faye B., Ndiop M., Diouf M., Diouf M., Diallo I., Fall F., Ndiaye J., Albertini A., Lee E., Jorgensen P., Gaye O., Bell D.


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