Influence of Rapid Malaria Diagnostic Tests on Treatment and Health Outcome in Fever Patients, Zanzibar—A Crossover Validation Study
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{"title"=>"Influence of rapid malaria diagnostic tests on treatment and health outcome in fever patients, Zanzibar - A crossover validation study", "type"=>"journal", "authors"=>[{"first_name"=>"Mwinyi I.", "last_name"=>"Msellem", "scopus_author_id"=>"8212017000"}, {"first_name"=>"Andreas", "last_name"=>"Mårtensson", "scopus_author_id"=>"8983786500"}, {"first_name"=>"Guida", "last_name"=>"Rotllant", "scopus_author_id"=>"23036418000"}, {"first_name"=>"Achuyt", "last_name"=>"Bhattarai", "scopus_author_id"=>"23033301000"}, {"first_name"=>"Johan", "last_name"=>"Strömberg", "scopus_author_id"=>"8983786700"}, {"first_name"=>"Elizeus", "last_name"=>"Kahigwa", "scopus_author_id"=>"6601959431"}, {"first_name"=>"Montse", "last_name"=>"Garcia", "scopus_author_id"=>"57198924763"}, {"first_name"=>"Max", "last_name"=>"Petzold", "scopus_author_id"=>"7003628893"}, {"first_name"=>"Peter", "last_name"=>"Olumese", "scopus_author_id"=>"6701757331"}, {"first_name"=>"Abdullah", "last_name"=>"Ali", "scopus_author_id"=>"36900151400"}, {"first_name"=>"Anders", "last_name"=>"Björkman", "scopus_author_id"=>"7006344603"}], "year"=>2009, "source"=>"PLoS Medicine", "identifiers"=>{"issn"=>"15491277", "scopus"=>"2-s2.0-66149141396", "sgr"=>"66149141396", "pui"=>"354637187", "isbn"=>"1549-1676 (Electronic)\\n1549-1277 (Linking)", "pmid"=>"19399156", "doi"=>"10.1371/journal.pmed.1000070"}, "id"=>"aff92edc-5e1c-34b0-8ac4-fa75433b0705", "abstract"=>"BACKGROUND: The use of rapid diagnostic tests (RDTs) for Plasmodium falciparum malaria is being suggested to improve diagnostic efficiency in peripheral health care settings in Africa. Such improved diagnostics are critical to minimize overuse and thereby delay development of resistance to artemisinin-based combination therapies (ACTs). Our objective was to study the influence of RDT-aided malaria diagnosis on drug prescriptions, health outcomes, and costs in primary health care settings.\\n\\nMETHODS AND FINDINGS: We conducted a cross-over validation clinical trial in four primary health care units in Zanzibar. Patients of all ages with reported fever in the previous 48 hours were eligible and allocated alternate weeks to RDT-aided malaria diagnosis or symptom-based clinical diagnosis (CD) alone. Follow-up was 14 days. ACT was to be prescribed to patients diagnosed with malaria in both groups. Statistical analyses with multilevel modelling were performed. A total of 1,887 patients were enrolled February through August 2005. RDT was associated with lower prescription rates of antimalarial treatment than CD alone, 361/1005 (36%) compared with 752/882 (85%) (odds ratio [OR] 0.04, 95% confidence interval [CI] 0.03-0.05, p<0.001). Prescriptions of antibiotics were higher after RDT than CD alone, i.e., 372/1005 (37%) and 235/882 (27%) (OR 1.8, 95%CI 1.5-2.2, p<0.001), respectively. Reattendance due to perceived unsuccessful clinical cure was lower after RDT 25/1005 (2.5%), than CD alone 43/882 (4.9%) (OR 0.5, 95% CI 0.3-0.9, p = 0.005). Total average cost per patient was similar: USD 2.47 and 2.37 after RDT and CD alone, respectively.\\n\\nCONCLUSIONS: RDTs resulted in improved adequate treatment and health outcomes without increased cost per patient. RDTs may represent a tool for improved management of patients with fever in peripheral health care settings.\\n\\nTRIAL REGISTRATION: (Clinicaltrials.gov) NCT00549003.", "link"=>"http://www.mendeley.com/research/influence-rapid-malaria-diagnostic-tests-treatment-health-outcome-fever-patients-zanzibar-crossover", "reader_count"=>158, "reader_count_by_academic_status"=>{"Unspecified"=>1, "Professor > Associate Professor"=>7, "Researcher"=>34, "Student > Doctoral Student"=>10, "Student > Ph. D. Student"=>26, "Student > Postgraduate"=>14, "Other"=>13, "Student > Master"=>31, "Student > Bachelor"=>8, "Lecturer"=>5, "Lecturer > Senior Lecturer"=>5, "Professor"=>4}, "reader_count_by_user_role"=>{"Unspecified"=>1, "Professor > Associate Professor"=>7, "Researcher"=>34, "Student > Doctoral Student"=>10, "Student > Ph. D. Student"=>26, "Student > Postgraduate"=>14, "Other"=>13, "Student > Master"=>31, "Student > Bachelor"=>8, "Lecturer"=>5, "Lecturer > Senior Lecturer"=>5, "Professor"=>4}, "reader_count_by_subject_area"=>{"Unspecified"=>5, "Agricultural and Biological Sciences"=>27, "Arts and Humanities"=>1, "Business, Management and Accounting"=>3, "Veterinary Science and Veterinary Medicine"=>1, "Computer Science"=>1, "Economics, Econometrics and Finance"=>4, "Engineering"=>2, "Environmental Science"=>3, "Biochemistry, Genetics and Molecular Biology"=>3, "Nursing and Health Professions"=>6, "Mathematics"=>2, "Medicine and Dentistry"=>84, "Pharmacology, Toxicology and Pharmaceutical Science"=>3, "Social Sciences"=>10, "Immunology and Microbiology"=>3}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>84}, "Social Sciences"=>{"Social Sciences"=>10}, "Mathematics"=>{"Mathematics"=>2}, "Unspecified"=>{"Unspecified"=>5}, "Environmental Science"=>{"Environmental Science"=>3}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>3}, "Arts and Humanities"=>{"Arts and Humanities"=>1}, "Engineering"=>{"Engineering"=>2}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>4}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>3}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>27}, "Computer Science"=>{"Computer Science"=>1}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>3}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>6}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>3}, "Veterinary Science and Veterinary Medicine"=>{"Veterinary Science and Veterinary Medicine"=>1}}, "reader_count_by_country"=>{"Canada"=>1, "Burkina Faso"=>1, "Belgium"=>2, "Tanzania"=>3, "United Kingdom"=>6, "Thailand"=>1, "Spain"=>1}, "group_count"=>9}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/899846"], "description"=>"<p>All estimates are based on an exchange rate of USD 1 = TSh 1,100. General costs = transport (USD 0.90)+consultation (USD 0.50)+RDT (USD 0.50) = USD 1.90. Drugs = ACT (USD 0.50−1.40)+antibiotics USD (0.30−0.90)+antipyretics (USD 0.05−0.20). Reattendance costs = transport (USD 0.90)+consultation (USD 0.50)+drugs (ACT, antibiotic+antipyretics = average USD 1.10) = USD 2.50.</p>", "links"=>[], "tags"=>["costs", "cd"], "article_id"=>570298, "categories"=>["Microbiology", "Infectious Diseases", "Physics", "Medicine"], "users"=>["Mwinyi I. Msellem", "Andreas Mårtensson", "Guida Rotllant", "Achuyt Bhattarai", "Johan Strömberg", "Elizeus Kahigwa", "Montse Garcia", "Max Petzold", "Peter Olumese", "Abdullah Ali", "Anders Björkman"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000070.t005", "stats"=>{"downloads"=>1, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Mean_total_costs_USD_per_patient_by_age_group_in_CD_RDT_and_CD_alone_groups_respectively_/570298", "title"=>"Mean total costs (USD) per patient by age group in CD+RDT and CD alone groups, respectively.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2009-04-28 00:04:58"}
  • {"files"=>["https://ndownloader.figshare.com/files/899721"], "description"=>"<p>RDT and CD in relation to blood slide results in all age groups combined.</p>", "links"=>[], "tags"=>["cd", "groups"], "article_id"=>570170, "categories"=>["Microbiology", "Infectious Diseases", "Physics", "Medicine"], "users"=>["Mwinyi I. Msellem", "Andreas Mårtensson", "Guida Rotllant", "Achuyt Bhattarai", "Johan Strömberg", "Elizeus Kahigwa", "Montse Garcia", "Max Petzold", "Peter Olumese", "Abdullah Ali", "Anders Björkman"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000070.t003", "stats"=>{"downloads"=>0, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_RDT_and_CD_in_relation_to_blood_slide_results_in_all_age_groups_combined_/570170", "title"=>"RDT and CD in relation to blood slide results in all age groups combined.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2009-04-28 00:02:50"}
  • {"files"=>["https://ndownloader.figshare.com/files/899764"], "description"=>"<p>Proportions of fever patients diagnosed as malaria by age group according to CD+RDT, CD alone, and microscopy.</p>", "links"=>[], "tags"=>["patients", "diagnosed", "malaria", "cd"], "article_id"=>570216, "categories"=>["Microbiology", "Infectious Diseases", "Physics", "Medicine"], "users"=>["Mwinyi I. Msellem", "Andreas Mårtensson", "Guida Rotllant", "Achuyt Bhattarai", "Johan Strömberg", "Elizeus Kahigwa", "Montse Garcia", "Max Petzold", "Peter Olumese", "Abdullah Ali", "Anders Björkman"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000070.t001", "stats"=>{"downloads"=>3, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Proportions_of_fever_patients_diagnosed_as_malaria_by_age_group_according_to_CD_RDT_CD_alone_and_microscopy_/570216", "title"=>"Proportions of fever patients diagnosed as malaria by age group according to CD+RDT, CD alone, and microscopy.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2009-04-28 00:03:36"}
  • {"files"=>["https://ndownloader.figshare.com/files/445266", "https://ndownloader.figshare.com/files/445410"], "description"=>"<div><h3>Background</h3><p>The use of rapid diagnostic tests (RDTs) for <em>Plasmodium falciparum</em> malaria is being suggested to improve diagnostic efficiency in peripheral health care settings in Africa. Such improved diagnostics are critical to minimize overuse and thereby delay development of resistance to artemisinin-based combination therapies (ACTs). Our objective was to study the influence of RDT-aided malaria diagnosis on drug prescriptions, health outcomes, and costs in primary health care settings.</p><h3>Methods and Findings</h3><p>We conducted a cross-over validation clinical trial in four primary health care units in Zanzibar. Patients of all ages with reported fever in the previous 48 hours were eligible and allocated alternate weeks to RDT-aided malaria diagnosis or symptom-based clinical diagnosis (CD) alone. Follow-up was 14 days. ACT was to be prescribed to patients diagnosed with malaria in both groups. Statistical analyses with multilevel modelling were performed. A total of 1,887 patients were enrolled February through August 2005. RDT was associated with lower prescription rates of antimalarial treatment than CD alone, 361/1005 (36%) compared with 752/882 (85%) (odds ratio [OR] 0.04, 95% confidence interval [CI] 0.03–0.05, <em>p</em><0.001). Prescriptions of antibiotics were higher after RDT than CD alone, i.e., 372/1005 (37%) and 235/882 (27%) (OR 1.8, 95%CI 1.5–2.2, <em>p</em><0.001), respectively. Reattendance due to perceived unsuccessful clinical cure was lower after RDT 25/1005 (2.5%), than CD alone 43/882 (4.9%) (OR 0.5, 95% CI 0.3–0.9, <em>p</em> = 0.005). Total average cost per patient was similar: USD 2.47 and 2.37 after RDT and CD alone, respectively.</p><h3>Conclusions</h3><p>RDTs resulted in improved adequate treatment and health outcomes without increased cost per patient. RDTs may represent a tool for improved management of patients with fever in peripheral health care settings.</p><h3>Trial Registration</h3><p>Clinicaltrials.gov <a href=\"http://clinicaltrials.gov/ct2/show/NCT00549003\">NCT00549003</a></p><h3></h3><p><em>Please see later in the article for Editors' Summary</em></p></div>", "links"=>[], "tags"=>["malaria", "diagnostic", "tests", "crossover", "validation"], "article_id"=>147759, "categories"=>["Microbiology", "Cancer", "Physics", "Medicine"], "users"=>["Mwinyi I. Msellem", "Andreas Mårtensson", "Guida Rotllant", "Achuyt Bhattarai", "Johan Strömberg", "Elizeus Kahigwa", "Montse Garcia", "Max Petzold", "Peter Olumese", "Abdullah Ali", "Anders Björkman"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1000070.s001", "https://dx.doi.org/10.1371/journal.pmed.1000070.s002"], "stats"=>{"downloads"=>37, "page_views"=>31, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Influence_of_Rapid_Malaria_Diagnostic_Tests_on_Treatment_and_Health_Outcome_in_Fever_Patients_Zanzibar_A_Crossover_Validation_Study/147759", "title"=>"Influence of Rapid Malaria Diagnostic Tests on Treatment and Health Outcome in Fever Patients, Zanzibar—A Crossover Validation Study", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2009-04-28 02:09:19"}
  • {"files"=>["https://ndownloader.figshare.com/files/899540"], "description"=>"<p>Flow of patients through the trial.</p>", "links"=>[], "tags"=>["patients"], "article_id"=>569995, "categories"=>["Microbiology", "Infectious Diseases", "Physics", "Medicine"], "users"=>["Mwinyi I. Msellem", "Andreas Mårtensson", "Guida Rotllant", "Achuyt Bhattarai", "Johan Strömberg", "Elizeus Kahigwa", "Montse Garcia", "Max Petzold", "Peter Olumese", "Abdullah Ali", "Anders Björkman"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000070.g001", "stats"=>{"downloads"=>1, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Flow_of_patients_through_the_trial_/569995", "title"=>"Flow of patients through the trial.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2009-04-28 02:46:35"}
  • {"files"=>["https://ndownloader.figshare.com/files/899671"], "description"=>"<p>Proportions of patients receiving antimalarial drugs and antibiotics in relation to day 0 microscopy results.</p>", "links"=>[], "tags"=>["patients", "receiving", "antimalarial", "drugs", "antibiotics", "microscopy"], "article_id"=>570117, "categories"=>["Microbiology", "Infectious Diseases", "Physics", "Medicine"], "users"=>["Mwinyi I. Msellem", "Andreas Mårtensson", "Guida Rotllant", "Achuyt Bhattarai", "Johan Strömberg", "Elizeus Kahigwa", "Montse Garcia", "Max Petzold", "Peter Olumese", "Abdullah Ali", "Anders Björkman"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000070.t002", "stats"=>{"downloads"=>0, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Proportions_of_patients_receiving_antimalarial_drugs_and_antibiotics_in_relation_to_day_0_microscopy_results_/570117", "title"=>"Proportions of patients receiving antimalarial drugs and antibiotics in relation to day 0 microscopy results.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2009-04-28 00:01:57"}
  • {"files"=>["https://ndownloader.figshare.com/files/899797"], "description"=>"<p>Sensitivities, specificities, and positive and negative predictive values in RDT and CD arms, respectively, in relation to blood slide results.</p>", "links"=>[], "tags"=>["predictive", "rdt", "cd"], "article_id"=>570244, "categories"=>["Microbiology", "Infectious Diseases", "Physics", "Medicine"], "users"=>["Mwinyi I. Msellem", "Andreas Mårtensson", "Guida Rotllant", "Achuyt Bhattarai", "Johan Strömberg", "Elizeus Kahigwa", "Montse Garcia", "Max Petzold", "Peter Olumese", "Abdullah Ali", "Anders Björkman"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000070.t004", "stats"=>{"downloads"=>2, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Sensitivities_specificities_and_positive_and_negative_predictive_values_in_RDT_and_CD_arms_respectively_in_relation_to_blood_slide_results_/570244", "title"=>"Sensitivities, specificities, and positive and negative predictive values in RDT and CD arms, respectively, in relation to blood slide results.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2009-04-28 00:04:04"}

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Relative Metric

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