![]() This malaria holoendemic area has been crippled by civil and international war and currently has limited health personnel and facilities. Pushing the use of RDTs to the periphery is an important priority if this technology is to benefit rural populations however, local conditions, such as malaria prevalence and pre-existing infrastructure, need to be considered for appropriate roll-out of this technology.Īs a promising strategy for improving capacity for malaria management, the use of RDTs by CHWs in a rural setting in eastern Democratic Republic of Congo was investigated. In Cambodia, for example, village malaria workers have provided accessible malaria diagnostic and treatment services in remote communities since 2001, in a programme which has been scaled-up to involve over 300 villages. Previous reports from South America, Asia and Africa have described the successful mobilization of community health workers to diagnose and treat malaria in remote villages using RDTs. ![]() In this setting, community health workers may represent a valuable human resource for the case management of malaria. However, operational questions remain as to how best to distribute and utilize RDTs, particularly in areas where the burden of malaria exceeds the health system capacity for malaria management. Lateral flow immunochromatographic devices, or rapid diagnostic tests (RDTs), offer the possibility of sensitive and specific field parasitological diagnosis of malaria through the detection of parasite antigen, such as histidine-rich protein 2. It is estimated that practical and accurate diagnostic tests for malaria diagnosis have the potential to avert 400 million unnecessary treatments and save 100,000 lives annually. However, several authors have noted that malaria misdiagnosis in endemic areas is common, resulting in harm to vulnerable populations. ![]() Conflict and human insecurity further amplify these challenges through a breakdown in health delivery systems, loss of human resources for health, and increase in the prevalence of infectious diseases such as malaria.Īccurate malaria diagnosis remains a cornerstone of global control efforts. The management of malaria in resource-poor areas is complicated by the lack of trained health professionals, the non-specific presentation of malaria (which may be indistinguishable clinically from benign viral illnesses or life threatening bacterial infections), and the lack of accessible and affordable diagnostic tools. Children in sub-Saharan Africa carry the highest burden of illness, accounting for 75% of all fatal cases. Malaria remains the leading parasitic cause of morbidity and mortality worldwide, causing an estimated 515 million clinical cases and 2 million deaths annually. ConclusionsĬHWs can safely and effectively use RDTs in their management of febrile children however, cost-effectiveness of RDTs is limited in zones of high malaria prevalence. However, high malaria prevalence in this cohort (93% by RDTs, 88% by light microscopy) limited the cost-effectiveness of RDTs compared to presumptive treatment of all febrile children, as evidenced by findings from a simplified decision analysis. ![]() CHWs were uniformly positive in evaluating RDTs for their utility and ease of use. Twelve CHWs were trained to safely and accurately perform and interpret RDTs, then successfully implemented rapid diagnostic testing in their remote community in a cohort of 357 febrile children. Prospective cohort study, satisfaction questionnaire and decision analysis. This study reports on a training programme for CHWs to incorporate RDTs into their management strategy for febrile children in the Democratic Republic of Congo, a tropical African setting ravaged by human conflict. Volunteer community health workers (CHWs) represent a potentially valuable human resource for expanding this technology to where it is most needed, remote rural communities in sub-Saharan Africa with limited health facilities and personnel. Accurate and practical malaria diagnostics, such as immunochromatographic rapid diagnostic tests (RDTs), have the potential to avert unnecessary treatments and save lives.
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