Reductions in artemisinin-based combination therapy consumption after the nationwide scale up of routine malaria rapid diagnostic testing in Zambia

Abstract

The National Malaria Control Center of Zambia introduced rapid diagnostic tests (RDTs) to detect Plasmodium falciparum as a pilot in some districts in 2005 and 2006; scale up at a national level was achieved in 2009. Data on RDT use, drug consumption, and diagnostic results were collected in three Zambian health districts to determine the impact RDTs had on malaria case management over the period 2004-2009. Reductions were seen in malaria diagnosis and antimalarial drug prescription (66.1 treatments per facility-month (95% confidence interval [CI] = 44.7-87.4) versus 26.6 treatments per facility-month (95% CI = 11.8-41.4)) pre- and post-RDT introduction. Results varied between districts, with significant reductions in low transmission areas but none in high areas. Rapid diagnostic tests may contribute to rationalization of treatment of febrile illness and reduce antimalarial drug consumption in Africa; however, their impact may be greater in lower transmission areas. National scale data will be necessary to confirm these findings.

Figure 1.

Location of study districts in Zambia.

Figure 2.

Trends in outpatient visits, malaria diagnosis, testing rate, test positivity rate and reporting completeness at study clinics. (Average value of the indicator across reporting facilities is shown as a solid line; the number of facilities reporting is shown with dotted line referring to left vertical axis in all figures.)

Figure 3.

Rates of testing, prescription, and malaria morbidity by district and overall. (Tested shown with solid line, confirmed cases with a dashed line (- - -), treated patients with a dotted and dashed line (- · -), and all malaria diagnoses shown with a dotted line ( ⋯ ). The A indicates the start of free insecticide treated net availability, the B indicates the average start of ACT use and the C indicates the average start of RDT use.)

Figure 4.

Ratio of treatment with ACT to confirmed malaria cases over time. (The solid line represents patients under five years of age the dashed line patients over five years of age and the dotted horizontal line the ideal ratio. The B indicates the average start-time of RDT use.)

Figure 5.

Mean treatments over time at study facilities. (The A indicates the start of free insecticide treated net availability, the B indicates the average start of ACT use and the C indicates the average start of RDT use.)