To mark the launch of a new series of advocacy briefs, the first of which is on the topic of malaria diagnostics, Malaria Consortium’s Senior Public Health Diagnostics Specialist, Elizabeth Streat, discusses why the universal and accurate diagnosis is so important in the fight against malaria.
Streat, along with a number of other Malaria Consortium technical staff, is attending the American Society of Tropical Medicine & Hygiene (ASTMH) Conference, where she is presenting an innovative system to assist malaria rapid diagnostic testing and reporting in the private sector. To find out more about Malaria Consortium’s presence at ASTMH, click here, or follow us @FightingMalaria #TropMed15
Why is accurate diagnosis of malaria so important?
Accurate diagnosis of malaria is important to ensure that patients receive the most effective treatment. The symptoms of malaria are similar to many other febrile illnesses, so making a correct diagnosis without a parasite-based confirmatory diagnostic test is difficult. If a patient receives the wrong diagnosis, then they will not receive the right treatment and potentially their life could be at risk. Besides the impact on the patient, treating patients with inappropriate medicine is a waste of valuable resources. The improper use of anti-malarials is also a contributing factor to the spread of drug resistant strains of the disease, which threatens to undermine international efforts to control malaria.
How is Malaria Consortium contributing to increasing the availability and use of malaria diagnostics?
Malaria Consortium contributes in a multitude of ways. We have pioneered the large-scale implementation of rapid diagnostic tests (RDTs) in all health service sectors, including in the community, in lower public health facilities, and – more recently – in the private sector, as part of the national malaria control programmes endeavours to achieve universal access to diagnosis. We have also strengthened national systems along the continuum of care, and have been at the forefront of the development and implementation of cost effective diagnostic quality assurance schemes for both microscopy and RDTs. Furthermore, we design and support national programmes in the implementation of innovative capacity building programmes, such as blended e-learning courses and e-health supervision and monitoring technology.
What is the significance of accurate diagnosis of malaria in the context of drug resistance?
Currently the only effective drugs we have to treat uncomplicated malaria are artemisinin-based combination therapies (ACTs). However, resistance is developing to artemisinin in the Greater Mekong Subregion of Southeast Asia. The use of monotherapies or sub-optimal doses of the treatment that are not able to clear parasites effectively is one of the factors contributing to the development of drug resistance. Ensuring that all patients are diagnosed using a parasite-based confirmatory test, and then treated appropriately, is an important step in halting the spread of drug resistance.
The presence of drug resistance can only be determined through the use of diagnostic tools. WHO drug efficacy testing protocols use the continued presence of symptoms and parasites seen by microscopy over 28 days. More recently, molecular markers to detect drug resistance are also being used. Once drug resistance has been detected, diagnosis continues to play an important role in monitoring the situation.
What role does the private sector play?
The private sector is the first place a majority of the population seeks care in many countries. Engaging the private sector is vital if countries are to achieve universal access to malaria diagnosis, as well as for there to be any significant improvement in the quality of care in that sector.
What are the key barriers to achieving universal diagnosis of malaria?
The general perception of both providers and patients is that the burden of malaria is higher than it really is - that all fevers equal malaria. Therefore, when diagnostics continue to return negative results, it undermines their confidence in the test. It is therefore important to ensure a continued supply of quality assured diagnostic tests, which allow providers to be confident of their results, and ensure that they are being used appropriately. Established quality assurance schemes and competency assessment checks are required to maintain standards and good practice.
Diagnostic tools are used to guide clinical decision making, and therefore testing cannot be separated from the provision of treatment. The availability of diagnostic tools alone may be insufficient to improve case management practices. Additional supportive interventions, such as well-designed training modules with an appropriate curriculum, and a better understanding of context, are necessary in order to have a more sustainable impact on practices.
What can policymakers do to support efforts to achieve universal diagnosis of malaria?
Malaria is a key priority area in the UN Secretary-General’s five year action agenda (2012-2017). To fully implement the global malaria strategy, which includes increased access to diagnostic testing, will require commitment and high-level political support from Governments and donors alike.
Policy makers should support efforts to achieve universal diagnosis of malaria, by advocating strongly for testing. Doing so will result in a better understanding of the disease burden in endemic countries, support surveillance, and improve case management practices - thereby bringing about greater efficiencies in national malaria control programmes. Diagnostic testing should therefore be included as a priority area for international aid.
To learn more about malaria diagnostics, including the policy recommendations for donors, governments, NGOs and the private sector, download Malaria Consortium’s new Malaria Diagnostics Advocacy Brief.