Successfully controlling malaria in South Africa

PKFollowing major successes in malaria control over the past 75 years, South Africa is now embarking on a malaria elimination campaign with the goal of zero local transmission by the year 2018. The key control elements have been intensive vector control, primarily through indoor residual spraying, case management based on parasitological diagnosis using evidence-based drug policies with artemisinin-based combination therapy since 2001, active health promotion in partnership with communities living in the malaria transmission areas, and cross-border collaborations. Political commitment and long-term funding for the malaria control programme have been a critical component of the programme’s success. Breaking the cycle of transmission through strengthening of active surveillance using sensitive molecular tests and field treatment of asymptomatic persons, monitoring for antimalarial drug resistance and insecticide resistance, strengthening cross-border initiatives, and ongoing programme advocacy in the face of a significant decrease in disease burden are key priorities for achieving the elimination goal

An evaluation of the performance and usage of ICT Pf malaria rapid diagnostic test, in the Limopo South Africa

Aim: This thesis aimed to evaluate the performance and usage of ICT Pf Malaria Rapid Diagnostic Test (MRDT), in an operational setting in the Limpopo Province, South Africa. Methods: Four studies were conducted to: assess factors affecting MRDT use (exploratory study- conducted as part of formative work); determine ICT Pf accuracy (cross-sectional study amongst 405 patients with prospective observational cohort component for follow-up); determine the performance of MRDT end-users (crosssectional observational study) and assess the suitability of using positive control antigen wells (PCWs) for routine quality control. Results: Key informants reported that MRDT accuracy, end-user proficiency and MRDT quality affect MRDT use and impact. The accuracy study found that sensitivity, specificity, positive and negative predictive values of ICT Pf test were 99.48% (99% Cl; 96.17-100.00%), 96.26% (99% Cl; 94.7-100%) 98.48 (99% Cl 98.41 -100.00%) and 96.26% (99% Cl 91.53-98.79%) respectively. Febrile patients with 'sweating' were 5 times more likely to be ICT Pf positive than those without sweating. Among the 68 patients who returned for day-seven follow up 23 (33%) were ICT Pf positive; however all were microscopy-negative. End-user proficiency: of the 15 recommended steps for MRDT use, 50% of end-users performed 11 or more steps correctly; 50% of end-users interpreted 90% of pre-prepared tests correctly. The false negative interpretation rate was 15%. The quality control study revealed that diluting PCWs with MRDT-negative blood gave better signals than diluting with citrate buffer. PCWs maintain signal strength when stored up to 30 days at 25°C at rural health clinics. Conclusions: Although ICT Pf MRDT can be used for malaria diagnosis in Limpopo, test sensitivity at low level parasitaemias in field settings need to be established. The ICT Pf test should not be used for assessing cure post-treatment. End-user proficiency needs improvement. PCWs can be used to monitor MRDT quality at PHC level

Field evaluation of a malaria rapid diagnostic test (ICT Pf)

Background. Malaria rapid diagnostic tests (MRDTs) are quickand easy to perform and useful for diagnosing malaria in primary health care settings. In South Africa most malaria infections are due to Plasmodium falciparum, and HRPII-based MRDTs have been used since 2001. Previous studies in Africa showed variability in sensitivity and specificity of HRPIIbased MRDTs; hence, we conducted a field evaluation in Limpopo province to determine the accuracy of the MRDTcurrently used in public sector clinics and hospitals.Methods. A cross-sectional observational study was conductedto determine the sensitivity and specificity of an ICT Pf MRDT. We tested 405 patients with fever with ICT Pf MRDT and compared the results with blood film microscopy (the gold standard).Results. The overall sensitivity of the ICT Pf MRDT was 99.48% (95% confidence interval (CI) 96.17 - 100%), while specificity was 96.26% (95% CI 94.7 - 100%). The positive predictive value of the test was 98.48 (99% CI 98.41 - 100%), and the negative predictive value was 99.52% (95% CI 96.47 – 100%).Conclusions. The ICT Pf MRDT is an appropriate test to use in the field in South Africa where laboratory facilities are not available. It has a high degree of sensitivity and acceptable level of specificity in accordance with the World Health Organization criteria. However, sensitivity of MRDT at low levels of parasitaemia

An exploratory study of factors that affect the performance and usage of rapid diagnostic tests for malaria in the Limpopo Province, South Africa

<p>Abstract</p> <p>Background</p> <p>Malaria rapid diagnostic tests (RDTs) are relatively simple to perform and provide results quickly for making treatment decisions. However, the accuracy and application of RDT results depends on several factors such as quality of the RDT, storage, transport and end user performance. A cross sectional survey to explore factors that affect the performance and use of RDTs was conducted in the primary care facilities in South Africa.</p> <p>Methods</p> <p>This study was conducted in three malaria risk sub-districts of the Limpopo Province, in South Africa. Twenty nurses were randomly selected from 17 primary health care facilities, three nurses from hospitals serving the study area and 10 other key informants, representing the managers of the malaria control programmes, routine and research laboratories, were interviewed, using semi-structured questionnaires.</p> <p>Results</p> <p>There was a high degree of efficiency in ordering and distribution of RDTs, however only 13/20 (65%) of the health facilities had appropriate air-conditioning and monitoring of room temperatures. Sixty percent (12/20) of the nurses did not receive any external training on conducting and interpreting RDT. Fifty percent of nurses (10/20) reported RDT stock-outs. Only 3/20 nurses mentioned that they periodically checked quality of RDT. Fifteen percent of nurses reported giving antimalarial drugs even if the RDT was negative.</p> <p>Conclusion</p> <p>Storage, quality assurance, end user training and use of RDT results for clinical decision making in primary care facilities in South Africa need to be improved. Further studies of the factors influencing the quality control of RDTs, their performance of RDTs and the ways to improve their use of RDTs are needed.</p

Case management of malaria: Treatment and chemoprophylaxis

Malaria case management is a vital component of programmatic strategies for malaria control and elimination. Malaria case management encompasses prompt and effective treatment to minimise morbidity and mortality, reduce transmission and prevent the emergence and spread of antimalarial drug resistance. Malaria is an acute illness that may progress rapidly to severe disease and death, especially in non-immune populations, if not diagnosed early and promptly treated with effective drugs. In this article, the focus is on malaria case management, addressing treatment, monitoring for parasite drug resistance, and the impact of drug resistance on treatment policies; it concludes with chemoprophylaxis and treatment strategies for malaria elimination in South Africa

Case management of malaria: Treatment and chemoprophylaxis

Malaria case management is a vital component of programmatic strategies for malaria control and elimination. Malaria case management encompasses prompt and effective treatment to minimise morbidity and mortality, reduce transmission and prevent the emergence and spread of antimalarial drug resistance. Malaria is an acute illness that may progress rapidly to severe disease and death, especially in non-immune populations, if not diagnosed early and promptly treated with effective drugs. In this article, the focus is on malaria case management, addressing treatment, monitoring for parasite drug resistance, and the impact of drug resistance on treatment policies; it concludes with chemoprophylaxis and treatment strategies for malaria elimination in South Africa.