The impact of the scale-up of malaria rapid diagnostic tests on the routine clinical diagnosis procedures for febrile illness : a series of repeated cross-sectional studies in Papua New Guinea

This paper examines the impact of the scale-up of malaria rapid diagnostic tests (RDT) on routine clinical diagnosis procedures for febrile illness in primary healthcare settings in Papua New Guinea.; Repeat, cross-sectional surveys in randomly selected primary healthcare services were conducted. Surveys included passive observation of consecutive febrile case management cases and were completed immediately prior to RDT scale-up (2011) and at 12- (2012) and 60-months (2016) post scale-up. The frequency with which specified diagnostic questions and procedures were observed to occur, with corresponding 95% CIs, was calculated for febrile patients prescribed anti-malarials pre- and post-RDT scale-up and between febrile patients who tested either negative or positive for malaria infection by RDT (post scale-up only).; A total of 1809 observations from 120 health facilities were completed across the three survey periods of which 915 (51%) were prescribed an anti-malarial. The mean number of diagnostic questions and procedures asked or performed, leading to anti-malarial prescription, remained consistent pre- and post-RDT scale-up (range 7.4-7.7). However, alterations in diagnostic content were evident with the RDT replacing body temperature as the primary diagnostic procedure performed (observed in 5.3 and 84.4% of cases, respectively, in 2011 vs. 77.9 and 58.2% of cases in 2016). Verbal questioning, especially experience of fever, cough and duration of symptoms, remained the most common feature of a diagnostic examination leading to anti-malarial prescription irrespective of RDT use (observed in 96.1, 86.8 and 84.8% of cases, respectively, in 2011 vs. 97.5, 76.6 and 85.7% of cases in 2016). Diagnostic content did not vary substantially by RDT result.; Rapid diagnostic tests scale-up has led to a reduction in body temperature measurement. Investigations are very limited when malaria infection is ruled out as a cause of febrile illness by RDT

Improving health worker adherence to malaria treatment guidelines in papua new Guinea : feasibility and acceptability of a text message reminder service

The aim of this study is to assess whether a text message reminder service designed to support health worker adherence to a revised malaria treatment protocol is feasible and acceptable in Papua New Guinea (PNG). The study took place in six purposively selected health facilities located in the Eastern Highlands Province (EHP) of PNG. Ten text messages designed to remind participants of key elements of the new NMTP were transmitted to 42 health workers twice over a two week period (two text messages per day, Monday to Friday) via the country's largest mobile network provider. The feasibility and acceptability of the text message reminder service was assessed by transmission reports, participant diaries and group discussions. Findings indicate that the vast majority of text messages were successfully transmitted, participants' had regular mobile phone access and that most text messages were read most of the time and were considered both acceptable and clinically useful. Nevertheless, the study found that PNG health workers may tire of the service if the same messages are repeated too many times and that health workers may be reluctant to utilize more comprehensive, yet complementary, resources. In conclusion, a text message reminder service to support health worker adherence to the new malaria treatment protocol is feasible and acceptable in PNG. A rigorous pragmatic, effectiveness trial would be justified on the basis of these findings

Text message content and transmission schedule.

<p>Text message content and transmission schedule.</p

Overview of text message transmission.

<p>Overview of text message transmission.</p

Estimates of malaria cases unseeking care by region in PNG (2011–2019).

Estimates of malaria cases unseeking care by region in PNG (2011–2019).</p

The average annual malaria incidence per 1000 in catchment areas of 772 health facilities, PNG (2011–2019).

Annual incidences were calculated as sum of adjusted presumptive and confirmed (using light microscopy or mRDTs) cases and estimates of patients unseeking care, among the population in the catchment area of the health facility. Source of the map base layer: WFP-World Food Programme, 2019. Map created by the authors using a licensed ArcGIS Desktop 10.5 software from Esri (http://www.arcgis.com/).</p

Cross-validation of empirical Bayesian kriging (EBK) models.

(TIF)</p

Summary of malaria reports at health facilities, PNG (2011–2019).

Summary of malaria reports at health facilities, PNG (2011–2019).</p

Malaria risk strata using the average annual incidence of cases among the general population, PNG, 2011–2019.

Four strata interpolated using empirical Bayesian kriging at catchments of HFs: very low (200 cases per 1000). Source of the map base layer: WFP-World Food Programme, 2019. Map created by the authors using a licensed ArcGIS Desktop 10.5 software from Esri (http://www.arcgis.com/).</p

Administrative and elevation maps of Papua New Guinea.

a) Administrative regions and provinces of Papua New Guinea. b) The elevation map of Papua New Guinea. The map shows altitude at a 90m resolution with a height accuracy of one meter. PNG has a central mountain range ranging northeast to southwest along the main island of the country. Data source: Global 3D elevation model TanDEM-X. (DOCX)</p