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12.05.2008 Health

Study On Alternative Diagnosis Of Malaria In Dangbe West

By Esi Asante, Dodowa - newtimesonline.com

IN a bid to stem the over-diagnosis of malaria and to reduce over prescription of malaria drugs, the Ghana Health Service in collaboration with the London School of Hygiene and tropical medicine, has instituted a study into the use of Rapid Diagnostic Tests (RDTs) in rural Ghana.

The two-year individually rando-mised control trial of the RDTs, is to determine the impact of the introduction of the RDTs on the appropriate presentation of anti-malaria in two settings, that is the microscopy setting (using laboratories) and clinical settings, (facilities without laboratories).

The objective of the study is to help improve the management of children with febrile illnesses (illnesses with fever) and non-febrile illnesses (illnesses without fever), to provide information on how to influence clinicians and patients behaviour with regards to three methods of malaria diagnosis, that is the microscopy, syndromic diagnosis and the RDTs.

The principal investigator on the project, Dr Evelyn Ansah, said the findings of the study currently under trial, will make room for RDTs to be adopted for malaria dignosis where there are no laboratories, especially in the rural areas.

This will stem over-diagnosis of malaria and reduce the over-prescription of malaria drugs in patients with fever symptoms at health centres.

She was giving a presentation of the trial study in the RDTs at Dodowa as part of a sensitisation programme organised by the Africa, Media and Malaria Research Network (AMMREN) Ghana, to commemorate World Malaria Day.

The sensitisation programme which included field trips to some malaria endemic areas in the Dangme West District including Dodowa, was to bring journalists and scientists working in Malaria related areas together, to forge closer links and to work together to reduce deaths through malaria.

Dr Ansah, who is also the Director of Health Services at Dodowa, said the study started last August, with funding from the Gates Malaria Partnership and that the findings has the potential to accurately direct the use of artermisine combination therapy (ACT), the WHO recommended anti-malaria drugs.

Giving a brief background of malaria diagnosis in Ghana, Dr Ansah said in 2005, Ghana changed the prescription of choloroquine as an anti-malaria drug in the treatment of malaria, to using the Articulate Amodiaquine, which was significantly more expensive.

Evidence she stated, showed that malaria was over diagnosed in the country using clinical diagnosis, stating that although high microscopy was introduced in the country, it was not easy to sustain its use and was not available in rural areas.

Thus an alternative method of diagnosing malaria in areas without microscopy equipment, was the Syndromic diagnosis, which itself was not always accurate.

Dr Ansah noted that the fear of experts was that if the over-diagnosis of malaria continue in the present era where ACT was the first line, intervention will be potentially more expensive and unsustainable.

The misuse of drugs in treatment of malaria she stressed, would also result in increasing drug pressure with its attendant drug resistance, as was the case with chloroquine.

She said to determine by means of the trial, the impact of the introduction of the RDTs, Dodowa, Prampram and Agomeda, in the Dangme West districts were chosen as trial sites.

She said, so far, since August 2007, the trial, in clinical settings, had screened 1,922 and observed 155 at Dodowa. Some 61 people did not meet the criteria, while two refused to participate in the trial.

In microscopic setting, that is using the only public sector laboratory at the Dodowa Health Centre and two private laboratories, 2,356 people were screened, 302 observed, 314 did not meet the criteria, while 52 refused consent to join the trial.

The screening is still ongoing she said and will end next year, adding that if the RDTs are observed to be cost-effective, then they could be deployed in similar malaria endemic areas.

Some field workers working on the trial, at the Dodowa Health Centre, said patients were showing interest and that they are able to screen about 35 patients each day.

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