Improving malaria diagnosis and treatment at primary health care level
28 October 2016
UAntwerpen, Campus Drie Eiken, Building Q, Promotiezaal - Universiteitsplein 1 - 2610 Wilrijk (route: UAntwerpen, Campus Drie Eiken
Hypolite Muhindo Mavoko
Prof J.-P. Van geertruyden & Prof P. Lutumba
PhD defence Hypolite Muhindo Mavoko - Faculty of Medicine and Health Sciences
Background and rationale
Despite a reduction in the incidence over the last decade, malaria remains a major problem of public health, with 214 million cases and 438,000 deaths occurring yearly. Malaria control was hindered by the spread of resistance of Plasmodium falciparum to the most available and affordable antimalarial drugs. As a response to that situation, the World Health Organization recommended the use of effective but expensive Artemisin-based Combination Therapies (ACTs) for first-line treatment of uncomplicated malaria cases, up on a confirmation of diagnosis. However, in the field reality, patients are, for several reasons, often treated regardless of the policies.
Design and methods
We conducted in the Democratic Republic of the Congo (DRC) and Uganda cross-sectional studies as well as a randomized, open label, 3-arm clinical trial, embedded in a cascade-cohort study.
We found that, at primary health care level (PHC), malaria rapid diagnostic tests (RDTs) are more reliable than microscopy in the diagnosis of malaria. A proof of concept of the multi-angle light scattering spectroscopy technique was described. This is a new technique that holds a potential to detect malaria. However, its accuracy in the field is still poor. Concerning treatment, we observed that only 45.7% of patients were managed in line with policies (ACTs prescribed to malaria positive patients and no antimalarial to the negative ones). In Kinshasa (DRC), the PCR-adjusted adequate clinical and parasitological response of artesunate-amodiaquine (ASAQ) was 92.8%. Polyclonal P. falciparum infections were predominant at recruitment as well as on the day of failure. All children harboring a single haplotype of P. falciparum were ACPR. The randomised clinical trial revealed a same or alternative ACT to be a suitable rescue treatment. Persistent recrudescences, over several treatment courses, were thought to contribute to the selection of resistant P. falciparum strains.
RDTs should be preferred at PHC for malaria diagnosis. ASAQ efficacy in Kinshasa is above the required threshold. ACTs (either the same or an alternative one) constitute the better option for rescue treatment. A focus of malaria prevention strategies on the hot spots is paramount.