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A Cluster Randomised Trial Introducing Rapid Diagnostic Tests into Registered Drug Shops in Uganda: Impact on Appropriate Treatment of Malaria

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Listed:
  • Anthony K Mbonye
  • Pascal Magnussen
  • Sham Lal
  • Kristian S Hansen
  • Bonnie Cundill
  • Clare Chandler
  • Siân E Clarke

Abstract

Background: Inappropriate treatment of malaria is widely reported particularly in areas where there is poor access to health facilities and self-treatment of fevers with anti-malarial drugs bought in shops is the most common form of care-seeking. The main objective of the study was to examine the impact of introducing rapid diagnostic tests for malaria (mRDTs) in registered drug shops in Uganda, with the aim to increase appropriate treatment of malaria with artemisinin-based combination therapy (ACT) in patients seeking treatment for fever in drug shops. Methods: A cluster-randomized trial of introducing mRDTs in registered drug shops was implemented in 20 geographical clusters of drug shops in Mukono district, central Uganda. Ten clusters were randomly allocated to the intervention (diagnostic confirmation of malaria by mRDT followed by ACT) and ten clusters to the control arm (presumptive treatment of fevers with ACT). Treatment decisions by providers were validated by microscopy on a reference blood slide collected at the time of consultation. The primary outcome was the proportion of febrile patients receiving appropriate treatment with ACT defined as: malaria patients with microscopically-confirmed presence of parasites in a peripheral blood smear receiving ACT or rectal artesunate, and patients with no malaria parasites not given ACT. Findings: A total of 15,517 eligible patients (8672 intervention and 6845 control) received treatment for fever between January-December 2011. The proportion of febrile patients who received appropriate ACT treatment was 72·9% versus 33·7% in the control arm; a difference of 36·1% (95% CI: 21·3 – 50·9), p

Suggested Citation

  • Anthony K Mbonye & Pascal Magnussen & Sham Lal & Kristian S Hansen & Bonnie Cundill & Clare Chandler & Siân E Clarke, 2015. "A Cluster Randomised Trial Introducing Rapid Diagnostic Tests into Registered Drug Shops in Uganda: Impact on Appropriate Treatment of Malaria," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-21, July.
    • Handle: RePEc:plo:pone00:0129545
    DOI: 10.1371/journal.pone.0129545
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    References listed on IDEAS

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    1. Chandler, Clare I.R. & Hall-Clifford, Rachel & Asaph, Turinde & Pascal, Magnussen & Clarke, Siân & Mbonye, Anthony K., 2011. "Introducing malaria rapid diagnostic tests at registered drug shops in Uganda: Limitations of diagnostic testing in the reality of diagnosis," Social Science & Medicine, Elsevier, vol. 72(6), pages 937-944, March.
    2. Guido J H Bastiaens & Teun Bousema & Toby Leslie, 2014. "Scale-up of Malaria Rapid Diagnostic Tests and Artemisinin-Based Combination Therapy: Challenges and Perspectives in Sub-Saharan Africa," PLOS Medicine, Public Library of Science, vol. 11(1), pages 1-4, January.
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    1. Kristian Schultz Hansen & Siân E Clarke & Sham Lal & Pascal Magnussen & Anthony K Mbonye, 2017. "Cost-effectiveness analysis of introducing malaria diagnostic testing in drug shops: A cluster-randomised trial in Uganda," PLOS ONE, Public Library of Science, vol. 12(12), pages 1-18, December.
    2. Cohen, Jessica & Saran, Indrani, 2018. "The impact of packaging and messaging on adherence to malaria treatment: Evidence from a randomized controlled trial in Uganda," Journal of Development Economics, Elsevier, vol. 134(C), pages 68-95.
    3. Oliver Van Hecke & Meriel Raymond & Joseph J Lee & Philip Turner & Clare R Goyder & Jan Y Verbakel & Ann Van den Bruel & Gail Hayward, 2020. "In-vitro diagnostic point-of-care tests in paediatric ambulatory care: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-28, July.
    4. Theodoor Visser & Katia Bruxvoort & Kathleen Maloney & Toby Leslie & Lawrence M Barat & Richard Allan & Evelyn K Ansah & Jennifer Anyanti & Ian Boulton & Siân E Clarke & Jessica L Cohen & Justin M Coh, 2017. "Introducing malaria rapid diagnostic tests in private medicine retail outlets: A systematic literature review," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-24, March.

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