Integrated community case management of fever in children under five using rapid diagnostic tests and respiratory rate counting: A multi-country cluster randomized trial

Authors: David Mukanga, Alfred B Tiono, Thomas Anyorigiya, Karin Ka¨ llander, Amadou T. Konate´ , Abraham R. Oduro, James K. Tibenderana, Lucas Amenga-Etego, Sodiomon B. Sirima, Simon Cousens, Guy Barnish, Franco Pagnoni

This effectiveness trial, conducted in Burkina Faso, Ghana and Uganda, compared a diagnostic and treatment package for malaria and pneumonia with presumptive treatment with antimalarial drugs.

Abstract

Evidence on the impact of using diagnostic tests in community case management of febrile children is limited. This effectiveness trial conducted in Burkina Faso, Ghana, and Uganda, compared a diagnostic and treatment package for malaria and pneumonia with presumptive treatment with anti-malarial drugs; artemisinin combination therapy (ACT). We enrolled 4,216 febrile children between 4 and 59 months of age in 2009–2010. Compliance with the malaria rapid diagnostic test (RDT) results was high in the intervention arm across the three countries, with only 4.9% (17 of 344) of RDT-negative children prescribed an ACT. Antibiotic overuse was more common: 0.9% (4 of 446) in Uganda, 38.5% (114 of 296) in Burkina Faso, and 44.6% (197 of 442) in Ghana. Fever clearance was high in both intervention and control arms at both Day 3 (97.8% versus 96.9%, P = 0.17) and Day 7 (99.2% versus 98.8%, P = 0.17). The use of diagnostic tests limits overuse of ACTs. Its impact on antibiotic overuse and on fever clearance is uncertain.

Published in the American Journal of Tropical Medicine and Hygiene

Citation: American Journal of Tropical Medicine and Hygiene, 2012; 87(Suppl 5): 21–29