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A trial that trained Ugandan shopkeepers to use subsidised malaria test kits could point to a way of reducing the misuse of malaria medicine.
In many poor nations, people often seek treatment for malaria at drug shops, but “a big problem is that most private sector outlets don’t offer diagnoses”, says lead author Jessica Cohen, a global health researcher at the Harvard T. H. Chan School of Public Health, United States.
Fever is a well-known symptom of malaria, so people with a temperature in countries where malaria is endemic often assume this is the cause and buy antimalarial drugs. Because several other diseases cause this symptom, this practice wastes valuable doses of artemisinin combination therapies, the front-line treatment for malaria.

“Better diagnosis can help, so scaling up diagnosis in the place where most people buy medicines makes sense.”

Jessica Cohen

“Better diagnosis can help, so scaling up diagnosis in the place where most people buy medicines makes sense,” explains Cohen.

The study, published on 20 January in the Bulletin of the WHO, took place in 79 villages in Uganda. The researchers trained drug shop staff in these villages in using malaria diagnostic kits and offered them subsidised kits.

According to the results, having rapid diagnostic tests available at local drug shops roughly doubled the number of patients who bought them and had the staff test them from about nine per cent before the intervention to 17.5 per cent afterwards.*

Shopkeepers were good at following the instructions for using and storing the tests, the study says. But it highlights a limited interest in restocking the tests. Out of the 92 shops in the trial, 37 did not buy replacement tests.

In addition, the paper shows that shopkeepers marked up the price of the tests. The average price patients paid for a test kit was 43 US cents, a 125 per cent profit for the shopkeeper.

“The study highlights that, with training and biosafety protocols in place, private sector providers can carry out rapid diagnostic tests safely and accurately,” says Elizabeth Streat, a diagnostics specialist with non-profit organisation the Malaria Consortium in Uganda. She thinks the model could increase access to testing.

But despite the tests increasing malaria diagnoses in the population, there was no statistically significant rise in the number buying appropriate medication. Additional interventions, such as working with various different types of provider, may be needed to achieve a higher coverage of testing and a higher rate of appropriate responses to tests, says Cohen.

Streat says such interventions must be accompanied by a behaviour change component so patients see the benefits of testing before any treatment.

* These figures were obtained by SciDev.Net from the authors. The paper lists the change as between about nine per cent and about 13 per cent, but the authors say this is an error.

> Link to the full paper in the Bulletin of the WHO


Bulletin of the WHO doi: 10.2471/BLT.14.142489 (2015)

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