Malaria diagnosis in most endemic countries was largely based on clinical symptoms that are non-specific. This resulted in the over-diagnosis and therefore, over-treatment of malaria, negation of other non-malarial febrile illness, exertion of drug pressures on the malaria parasites with fear of early on-set of drug resistance etc. The gold standard for malaria diagnosis, microscopy, requires high skills, long training, electricity, laboratory equipment, reagents and the turn-around-time for the malaria test could be extremely long in a number of settings and thus not available to guide the prescription of antimalaria medicines. The need for a rapid malaria test was therefore imperative for an effective malaria case management. The availability of good performing malaria rapid diagnostic tests (RDTs) has made the paradigm shift from clinical diagnosis to parasite-based confirmation of malaria a possibility.
In the last decade, millions of RDTs for malaria have been implemented worldwide. These simple and easy-to-use tests can diagnose malaria from blood in about 15 minutes, making a diagnostic possible at all levels of the health system. While the tests have enabled better access to malaria diagnosis, many challenges remain.
Members and panelists from The London School of Hygiene and Tropical Medicine, The Foundation for Innovative New Diagnostics (FIND), The University of Lagos, The University of Yaounde I, PATH, USAID/Deliver Project, and the U.S. Food and Drug Administration (FDA) addressed many challenges in this three-part discussion: interpreting test results in context; the impact of RDTs on the behavior of health care providers; the implications of the WHO “test and treat” guidelines; as well as regulations and procurement issues.
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