Effectiveness Of Rapid Diagnostic Tests in the New Context of Low Malaria Endemicity in Zanzibar
Effectiveness Of Rapid Diagnostic Tests in the New Context of Low Malaria Endemicity in Zanzibar
The purpose of this study is to study the effectiveness of wide scale RDT use at the primary
 health care level in previously high malaria endemic area during malaria pre-elimination
 phase for improved targeting of anti-malarial drugs, malaria surveillance and epidemic
 alertness.
During the last 6 years Zanzibar has undergone a dramatic change in malaria epidemiology and
 burden of disease, with a marked decline of Plasmodium falciparum malaria among febrile
 children from approximately 30% to 1% or below and a reduction of crude child mortality of
 50% Overuse of the expensive ACTs will not only be a substantial financial burden on the
 health care system in Zanzibar, but will also spur anti-malarial drug resistance with
 devastating effect on global malaria control efforts and prevent other causes of fever from
 being appropriately treated, e.g. pneumonias which require antibiotics. Rapid Diagnostic
 Tests (RDTs), based on antigen detection of P. falciparum, are proposed as a future
 cornerstone to improve diagnostic efficiency also at the peripheral health care level beyond
 the reach of microscopy services

 IMCI algorithms based on clinical symptoms could potentially be made more efficient and cost
 effective if simple parasitological diagnostic methodologies were incorporated. Zanzibar is
 among the first regions to incorporate RDT in the IMCI guidelines in Africa, which provides a
 unique research opportunity to scientifically evaluate the effectiveness of incorporating RDT
 in the existing IMCI algorithm.

 Another key challenge for Zanzibar is to monitor potential development of parasite resistance
 to ACT when the number of malaria positive patients is insufficient to conduct standard in
 vivo efficacy trials. We propose that RDT could play a critical new role also in this regard.
Inclusion Criteria:

 -  All patients >2 months of age with confirmed fever, with a measured axillary
 temperature of ≥37.5˚C, or history of fever within the preceding 24 hours

 -  Presenting to the health facility from 8.00 to 16.00 Monday to Friday.

 -  Informed consent

 Exclusion Criteria:

 -  Previous enrolment in the study within the last 28 days.

 -  Severe disease that requires immediate referral as defined by the clinician