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London School of Hygiene & Tropical Medicine Malaria Centre

Malaria clinical trials and studies

Evaluation of malaria diagnostic strategies in South Central Asian health facilities where vivax is co-endemic with falciparum.

LSHTM investigators:
Toby Leslie, Amy Mikhail, Chris Whitty & Mark Rowland.
External collaborators:
HealthNet TPO; MERLIN & Health Protection and Research Organisation.
Funding body:
The Bill & Melinda Gates Foundation through the ACT Consortium.

Malaria in many areas outside Africa is a consequence of two or more species; in Afghanistan and surrounding countries, the less-often fatal or serious vivax malaria predominates although falciparum is also seen.

This situation complicates diagnosis and treatment of malaria and requires that malaria cases are accurately diagnosed and treatment is targeted at the specific species. In health facilities in low-income countries this is a challenge. Our study aims to assess the effectiveness of current strategies to provide accurate diagnosis and treatment for malaria and non-malarial fevers.

Although rapid diagnostic tests appear more accurate than conventional light microscopy, the study shows that around 50% of patients who do not have malaria, based on a laboratory diagnostic result, received an antimalarial regardless of the negative parasite diagnosis.

The situation decreases the cost-effectiveness of rapid diagnostic tests and results in cases of potentially severe non-malarial febrile illness being mistreated as malaria. Improved guidelines which emphasise the importance of treatment according to laboratory diagnostic results will be part of the solution, but ensuring changes in treatment practice that are sustainable will also require additional point of care diagnostics for alternative, non-malarial causes of febrile illness.