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Does Africa have the capacity to support laboratory-confirmed diagnosis and treatment of malaria in children under five, or should it continue to presumptively treat all fever episodes with antimalarial drugs? In a PLoS Medicine debate, Valerie D'Acremont and colleagues argue for the move, while Mike English and colleagues argue against it.

New rapid diagnostic tests (RTDs) are sensitive, simple and accurate says D'Acremont and colleagues. False-negative results kill fewer patients than those mistakenly treated for malaria.

Drug wastage, unnecessary adverse reactions, increased parasite resistance and potential mistrust of artemisinin-based combination therapies are all reasons why laboratory-confirmed diagnosis and treatment should be pursued in Africa, they say.

But, argue English and colleagues, RDTs in practice show poor sensitivity and a worrying 19–86 per cent variability between sites.

They say that health workers often ignore diagnostic results and prescribe antimalarials to negative cases, which limits the cost-effectiveness of using RDTs. African health systems are incapable of reliably purchasing and delivering drugs — adding, and supervising, RDTs would be a huge challenge, they add.

Both groups agree that if rapid diagnostic testing is to replace presumptive antimalarial treatment for children in malaria-endemic areas, better planning, more safety information, and improved implementation and management are needed.

Link to full article in PLoS Medicine (D’Acremont et al)

Link to full article in PLoS Medicine (English et al)