Diagnostic testing of suspected malaria is low and inequitable at the outset of new WHO guidelines

“It will be difficult to achieve the new WHO “universal testing” policy in most endemic countries since pediatric fevers are commonly managed at home or in community settings where diagnostics are near absent”, says Emily White Johansson, first author of the study and researcher at the Department of Women’s and Children’s Health, Uppsala University.

Greater testing is needed at lower or less formal care sources where pediatric fevers are commonly managed, particularly to reach the poorest.

In 2010, the World Health Organization revised treatment guidelines to recommend diagnosis of all suspected malaria cases prior to treatment.  The shift from presumptive treatment of febrile children to test-based case management has great potential to improve rational drug use and management of febrile illnesses so that children with other fever causes (e.g. pneumonia) do not get treated with anti-malarias. Countries are now heavily investing in malaria rapid diagnostic tests in order to achieve universal test coverage in line with revised international guidelines.

Despite this investment, there has been no systematic assessment of malaria test use at the population level as countries start scaling up diagnostics. There is also limited understanding of factors associated with test uptake for pediatric fevers, particularly in relation to patterns of malaria endemicity and treatment seeking behavior that may vary substantially within countries.  

Test uptake was lowest among children at highest risk of malaria, which could plausibly be due to entrenched presumptive treatment practices in these regions. It is plausible that health workers are accustomed to treating all fever cases in children as ‘malaria’ in high-risk areas.

“This merits urgent investigation since it has potential implications for diagnostic scale up in the highest-risk settings”, says Emily White Johansson.

The study is based on data from national population-based surveys from 13 countries in sub-Saharan Africa in 2009-2011, with a specific focus on children under five years.

Reference: White-Johansson et al, Diagnostic testing of Pediatric fever. http://dx.plos.org/10.1371/journal.pone.0095483

For more information, please contact Emily White Johansson, mobile: +1 347 558 3981 (USA), e-mail: emily.johansson@kbh.uu.se.