Strict adherence to malaria rapid test results might lead to a neglect of other dangerous diseases: a cost benefit analysis from Burkina Faso

<p>Abstract</p> <p>Background</p> <p>Malaria rapid diagnostic tests (RDTs) have generally been found reliable and cost-effective. In Burkina Faso, the adherence of prescribers to the negative test result was found to be poor. Moreover, the test accuracy for malaria-attributable fever (MAF) is not the same as for malaria infection. This paper aims at determining the costs and benefits of two competing strategies for the management of MAF: presumptive treatment for all or use of RDTs.</p> <p>Methods</p> <p>A cost benefit analysis was carried out using a decision tree, based on data previously obtained, including a randomized controlled trial (RCT) recruiting 852 febrile patients during the dry season and 1,317 in the rainy season. Cost and benefit were calculated using both the real adherence found by the RCT and assuming an ideal adherence of 90% with the negative result. The main parameters were submitted to sensitivity analysis.</p> <p>Results and discussion</p> <p>At real adherence, the test-based strategy was dominated. Assuming ideal adherence, at the value of 525 € for a death averted, the total cost of managing 1,000 febrile children was 1,747 vs. 1,862 € in the dry season and 1,372 vs. 2,138 in the rainy season for the presumptive vs. the test-based strategy. For adults it was 2,728 vs. 1,983 and 2,604 vs. 2,225, respectively. At the subsidized policy adopted locally, assuming ideal adherence, the RDT would be the winning strategy for adults in both seasons and for children in the dry season.</p> <p>At sensitivity analysis, the factors most influencing the choice of the better strategy were the value assigned to a death averted and the proportion of potentially severe NMFI treated with antibiotics in patients with false positive RDT results. The test-based strategy appears advantageous for adults if a satisfactory adherence could be achieved. For children the presumptive strategy remains the best choice for a wide range of scenarios.</p> <p>Conclusions</p> <p>For RDTs to be preferred, a positive result should not influence the decision to treat a potentially severe NMFI with antibiotics. In the rainy season the presumptive strategy always remains the better choice for children.</p

Respondent-reported morbidity; mortality, morbidity and health-seeking behaviour survey during the Ebola epidemic in Monrovia, Liberia, May 2014-March 2015.

<p>Respondent-reported morbidity; mortality, morbidity and health-seeking behaviour survey during the Ebola epidemic in Monrovia, Liberia, May 2014-March 2015.</p

Characteristics of deceased cases (n = 55); mortality, morbidity and health-seeking behaviour survey during the Ebola epidemic in Monrovia, Liberia, May 2014-March 2015.

<p>Characteristics of deceased cases (n = 55); mortality, morbidity and health-seeking behaviour survey during the Ebola epidemic in Monrovia, Liberia, May 2014-March 2015.</p

Changes in household composition among respondents; mortality, morbidity and health-seeking behaviour survey during the Ebola epidemic in Monrovia, Liberia, May 2014-March 2015.

<p>Changes in household composition among respondents; mortality, morbidity and health-seeking behaviour survey during the Ebola epidemic in Monrovia, Liberia, May 2014-March 2015.</p

Number of households And household members included in the survey by neighbourhood of residence; mortality, morbidity and health-seeking behaviour survey during the Ebola epidemic in Monrovia, Liberia, May 2014-March 2015.

<p>Number of households And household members included in the survey by neighbourhood of residence; mortality, morbidity and health-seeking behaviour survey during the Ebola epidemic in Monrovia, Liberia, May 2014-March 2015.</p

Accuracy of a rapid diagnostic test on the diagnosis of malaria infection and of malaria - attributable fever during low and high transmission season in Burkina Faso

<p>Abstract</p> <p>Background</p> <p>Malaria management policies currently recommend that the treatment should only be administered after laboratory confirmation. Where microscopy is not available, rapid diagnostic tests (RDTs) are the usual alternative. Conclusive evidence is still lacking on the safety of a test-based strategy for children. Moreover, no formal attempt has been made to estimate RDTs accuracy on malaria-attributable fever. This study aims at estimating the accuracy of a RDT for the diagnosis of both malaria infection and malaria - attributable fever, in a region of Burkina Faso with a typically seasonal malaria transmission pattern.</p> <p>Methods</p> <p>Cross-sectional study. Subjects: all patients aged > 6 months consulting during the study periods. Gold standard for the diagnosis of malaria infection was microscopy. Gold standard for malaria-attributable fever was the number of fevers attributable to malaria, estimated by comparing parasite densities of febrile versus non-febrile subjects. Exclusion criteria: severe clinical condition needing urgent care.</p> <p>Results</p> <p>In the dry season, 186/852 patients with fever (22%) and 213/1,382 patients without fever (15%) had a <it>Plasmodium falciparum </it>infection. In the rainy season, this proportion was 841/1,317 (64%) and 623/1,669 (37%), respectively. The attributable fraction of fever to malaria was 11% and 69%, respectively. The RDT was positive in 113/400 (28.3%) fever cases in the dry season, and in 443/650 (68.2%) in the rainy season. In the dry season, the RDT sensitivity and specificity for malaria infection were 86% and 90% respectively. In the rainy season they were 94% and 78% respectively. In the dry season, the RDT sensitivity and specificity for malaria-attributable fever were 94% and 75%, the positive predictive value (PPV) was 9% and the negative predictive value (NPV) was 99.8%. In the rainy season the test sensitivity for malaria-attributable fever was 97% and specificity was 55%. The PPV ranged from 38% for adults to 82% for infants, while the NPV ranged from 84% for infants to over 99% for adults.</p> <p>Conclusions</p> <p>In the dry season the RDT has a low positive predictive value, but a very high negative predictive value for malaria-attributable fever. In the rainy season the negative test safely excludes malaria in adults but not in children.</p