A community approach can improve the rational use of antimalarials
Newly available tests that can diagnose malaria almost instantly can make a big difference and will help prevent the over diagnosis of malaria, according to a series of new studies by TDR. Over diagnosis of malaria and the consequent overuse of antimalarial drugs is dangerous because it can breed resistant strains of parasites and because it is a waste of limited resources.
Four concurrent studies evaluating the use of diagnostic tools for both malaria and pneumonia were carried out from 2008 to 2009 in Burkina Faso, Ghana, Uganda, and Nigeria. The studies tested the integrated community case management approach in 25,000 people across the four countries to see whether the diagnosis and prescription of antimalarials and antibiotics improved with the new diagnostic tools – rapid diagnostic tests (RDTs) for malaria, and a respiratory rate count for pneumonia. The analysis of the four studies was just completed in early 2011.
The studies compared one group, using the diagnostic tools, with another that was given the traditional home management strategy, which is to give anti-malarial drugs to every sick child without doing a diagnostic test. Antibiotics for pneumonia were not prescribed in the control group because they are not part of the traditional home management strategy.
The results showed a dramatic overuse of antimalarials in the control group, of around 50 percent, said Dr Franco Pagnoni, a specialist on antimalarial policy at TDR who led the research. The overuse in the intervention group was just 3 percent.
“These studies show that an integrated community case management strategy can really improve rational use of antimalarials,” said Dr Pagnoni.
In the case of pneumonia, the intervention group that received diagnosis and treatment by community health workers was found to be overprescribed medication by about 20 percent. However, that is close to the rate of over prescription by nurses and doctors in dispensaries and hospitals, said Dr Pagnoni. While better diagnostics are still needed for pneumonia, the integrated community case management approach is a valuable tool that should be implemented for now, said Dr Pagnoni.
For more information contact Dr Franco Pagnoni, pagnonif@who.int
