RDTs vs. Presumptive Treatment: Medical Science vs. Pragmatism/ Economics | Global Health Delivery Online: Improving health care delivery through global collaboration

Discussion Brief

Effective case management of malaria is essential in the context of increasing drug resistance. The recent WHO guidelines recommend prompt parasitological confirmation by microscopy or alternatively by Rapid Diagnostic Tests (RDTs) in all patients suspected of malaria before treatment is started, and that treatment solely based on clinical suspicion should only be considered when a parasitological diagnosis is not accessible.

In malaria-endemic countries, people commonly assume they have malaria when sick and treat themselves accordingly. Of equal concern is that negative test results—meaning no malaria—are often ignored and patients treated anyway. (Whitty, 2008; Juma, 2011). Although RDTs have been shown to be robust diagnostic tools, and a couple are commonly used in countries (Batwala, 2010; Singh, 2005), “one size does not fit all;” If parasite prevalence in the population is low, a diagnostic test is relevant; if the prevalence is high, the test does not provide information of any clinical usefulness, as happens with any test in medicine when the prevalence of the tested characteristic is high in the healthy population. (Grass, 2011)

Members representing a broad range of health professions and organizations spanning four continents (Asia, Africa, North America and Europe) discuss challenges in misdiagnosis and presumptive treatment, as well as policy, training, and behavior change.
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