Interactive training halves malaria overdiagnosis and prevents wastage of drugs

April 24, 2014, London School of Hygiene & Tropical Medicine

Interactive training programmes for health workers could reduce overdiagnosis of malaria by half and help prevent valuable drugs from being wasted on patients who don't have the disease, according to new research published on World Malaria Day in The Lancet Global Health. The study shows that the roll-out of malaria rapid diagnostic tests (RDTs) in endemic countries should run alongside these new training programmes.

The study in Cameroon, carried out by the Artemisinin-based Combination Therapy (ACT) Consortium based at the London School of Hygiene & Tropical Medicine, compared the use of RDTs when packaged with either a basic or a comprehensive programme for clinicians. Their results showed that those undertaking the comprehensive programme were much less likely to overuse antimalarials. Only 31% of patients in this group received a drug that they didn't need, compared to 52% in the group undertaking the basic programme and 84% in the control group which represented the standard practice.

The more effective training package lasted three days and was designed to change prescribing practices. In addition to the content of the basic package, which only provided conventional training on RDTs, malaria diagnosis and treatment, the comprehensive package had smaller groups and longer discussions about clinical guidelines, real-life scenarios and effective communication with patients. It was also more interactive, using card games, drama and problem solving exercises.

This research was carried out in response to calls from governments to provide evidence that helps to change the behaviour of clinicians, who often treat patients based on their signs and symptoms without testing their blood for the presence of malaria parasites. This often results in patients with fever being overdiagnosed with malaria and receiving expensive malaria treatment that they don't need.

The study's lead author, Dr Virginia Wiseman from the London School of Hygiene & Tropical Medicine, said: "If we are serious about improving the targeting of malaria medicines by using RDTs, then there needs to be a far greater focus on behaviour change. This study, the first of its kind in Cameroon, highlights that not only need training to diagnose and treat malaria, but most of all need the confidence to put what they learn into practice and to communicate more effectively with patients about why they are tested and that fever is not always caused by malaria. Our results suggest that a good training programme designed to translate knowledge into practice could dramatically reduce overdiagnosis of malaria in Cameroon and prevent the wastage of valuable medicines."

The World Health Organization recommends that health workers test patients for malaria before prescribing antimalarial treatment, but for decades malaria has been diagnosed based on symptoms alone. Microscopy is a method that requires laboratory equipment and qualified staff, while rapid diagnostic tests are alternative, simple tools to diagnose malaria accurately which can help health workers in remote locations to prescribe the correct treatment.

Professor David Schellenberg, director of the ACT Consortium at the London School of Hygiene & Tropical Medicine, said: "This study shows that can take the guesswork out of diagnosis, which can improve the targeting of to those who really need it. We recognise that this is one study carried out in one setting, in one country, but it helps us to maximise the value of RDTs in different contexts such as the private sector or other countries. It also draws attention to the importance of understanding the non-malarial causes of fever. For example, meningitis or pneumonia are life-saving infections and require referral and additional treatment."

Prof Wilfred Mbacham from the University of Yaoundé, who co-led the study in Cameroon, said: "Rapid are new technologies that can greatly assist nurses and doctors in making life-saving decisions at the point-of-care. Rather than do passive training in the use of RDTs, building confidence and providing communication training are key to accept a negative test for a patient with fever and to use other treatment options. We reached this result through repeated consultations with the National Malaria Control Programme. Governments need to minimally invest in building up the critical mass of health workers who prescribe appropriately, which requires a curriculum change in medical schools."

Explore further: The effects of rapid diagnostic tests for malaria in African healthcare settings

More information: Basic or enhanced clinician training to improve adherence to malaria treatment guidelines: a cluster-randomised trial in two areas of Cameroon, Mbacham et al, Lancet Global Health 2014, Published Online April 25, 2014, dx.doi.org/10.1016/S2214-109X(14)70201-3

Related Stories

The effects of rapid diagnostic tests for malaria in African healthcare settings

April 18, 2014
Researchers from the Cochrane Infectious Diseases Group conducted a review of the effects of introducing rapid diagnostic tests (RDTs) for diagnosing malaria in primary healthcare settings in Africa where laboratory services ...

Simple rapid diagnostic tests for malaria work well

July 6, 2011
When a person living in a malarial area gets a fever, health workers need to know the cause to make absolutely sure they give the right treatment. For many years in sub-Saharan Africa primary health workers have often assumed ...

New WHO test-based approach against malaria does not work everywhere

July 1, 2013
In view of the sharp rise in treatment costs of malaria, the World Health Organization (WHO) says that there must be a hard diagnosis before the disease is treated. The WHO is deploying rapid tests, a variation of the well-known ...

How the immune system prevents repeated malaria fever episodes in highly exposed children

April 17, 2014
Children in Mali (and many other regions where malaria is common) are infected with malaria parasites more than 100 times a year, but they get sick with malaria fever only a few times. To understand how the immune system ...

Malaria screening unsuccessful in some schools

January 28, 2014
A school-based intermittent screening and treatment program for malaria in rural coastal Kenya had no benefits on the health and education of school children, according to a study by international researchers published in ...

African fever patients commonly over-diagnosed with malaria

July 19, 2013
People hospitalised with fever in Africa are most likely to be treated for malaria but, in some areas, nearly all of these patients are ill from a different infection, a new collaborative study led by a University of Otago ...

Recommended for you

Creation of synthetic horsepox virus could lead to more effective smallpox vaccine

January 19, 2018
UAlberta researchers created a new synthetic virus that could lead to the development of a more effective vaccine against smallpox. The discovery demonstrates how techniques based on the use of synthetic DNA can be used to ...

Study ends debate over role of steroids in treating septic shock

January 19, 2018
The results from the largest ever study of septic shock could improve treatment for critically ill patients and save health systems worldwide hundreds of millions of dollars each year.

New approach could help curtail hospitalizations due to influenza infection

January 18, 2018
More than 700,000 Americans were hospitalized due to illnesses associated with the seasonal flu during the 2014-15 flu season, according to federal estimates. A radical new approach to vaccine development at UCLA may help ...

Zika virus damages placenta, which may explain malformed babies

January 18, 2018
Though the Zika virus is widely known for a recent outbreak that caused children to be born with microencephaly, or having a small head, and other malformations, scientists have struggled to explain how the virus affects ...

Certain flu virus mutations may compensate for fitness costs of other mutations

January 18, 2018
Seasonal flu viruses continually undergo mutations that help them evade the human immune system, but some of these mutations can reduce a virus's potency. According to new research published in PLOS Pathogens, certain mutations ...

Study reveals how MRSA infection compromises lymphatic function

January 17, 2018
Infections of the skin or other soft tissues with the hard-to-treat MRSA (methicillin-resistant Staphylococcus aureus) bacteria appear to permanently compromise the lymphatic system, which is crucial to immune system function. ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.