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[NAIROBI] Comprehensive training of health workers could cut to half malaria overdiagnosis, according to a new study.

The WHO guidelines recommend that patients’ blood should be tested for malaria parasites before prescribing medicines, but the researchers say many malaria-endemic countries often rely on symptoms rather than blood testing for treatment. 

The study, conducted between 7 June and 14 December 2011 at 46 public and mission health facilities in Yaoundé and Bamenda in Cameroon, and published in The Lancet Global Health last month (25 April), was aimed at assessing the impact of Rapid Diagnostic Tests (RDTs) and training on malaria treatment.

“When health workers diagnose on the basis of symptoms alone, which is common in many parts of Africa, there is a danger of overdiagnosis, which can harm the patient.”

Virginia Wiseman, London School of Hygiene and Tropical Medicine, United Kingdom

The researchers randomised the health facilities into three groups: a control group that received no training, a group that received a one-day basic training on RDTs and a third group that was offered a three-day comprehensive training on RDTs.

They surveyed 681 patients who attended the health facilities that received no training, 1,632 patients from facilities in the basic training group and 1,669 from facilities in the comprehensive training group between 3 October and 14 December 2011.

The researchers found out that inappropriate use of malaria drugs after a negative test was reduced from 84 per cent in the control group — representing the standard practice in Cameroon — to 52 per cent and 31 per cent, respectively in health facilities where clinicians received basic and comprehensive training.

“When health workers diagnose on the basis of symptoms alone, which is common in many parts of Africa, there is a danger of overdiagnosis, which can harm the patient,” says Virginia Wiseman, lead author of the study and senior lecturer at the UK-based London School of Hygiene and Tropical Medicine

Wiseman adds that fever could result from life-threatening conditions, including meningitis and pneumonia and that training clinicians to use RDTs could prevent waste of valuable malaria drugs and resources for developing regions such as Sub-Saharan Africa.

Kiambo Njagi, a medical entomologist at the Division of Malaria Control of Kenya’s Ministry of Health who was not involved in the study, tells SciDev.Net:  “RDTs are simple to use and don’t require highly-trained laboratory technicians often missing in remote regions of Africa”.

Njagi says that advocacy could facilitate behavioural change among clinicians, but adds that the training can only be effective if clinicians are given the tools for detecting malaria parasites.

Wilfred Mbacham, co-author of the study and professor of public health biotechnology at the University of Yaoundé, agrees, noting that the potential of RDTs may not be realised unless clinicians receive sufficient training, trust their results and have the confidence or resources to treat alternative causes of fever.

According to the WHO, malaria caused close to 700,000 deaths globally in 2012. Those at risk are pregnant women and children below the age of five in developing nations,with Africa most affected.

Link to full study inThe Lancet Global Health*

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This article has been produced by SciDev.Net's Sub-Saharan Africa desk.


The Lancet Global Health doi 10.1016/S2214-109X(14)70201-3 (2014)

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