COMMUNITY-BASED DIAGNOSIS AND MANAGEMENT OF CHILDHOOD MALARIA USING RAPID DIAGNOSTIC TEST AND MANAGEMENT WITH ARTEMISININ –BASED COMBINATION THERAPY IN TARABA STATE-NIGERIA
ABSTRACT
A cross-sectional study was conducted for fifteen (15) months (May, 2012 to July, 2013) to assess the efficacy of Rapid Diagnostic Test (RDT) in diagnosis followed by treatment of childhood malaria with Artemisinin – Based Combination Therapy (ACT) at community level in Taraba State. A total of 840 symptomatic children aged two months to thirteen years were presented for diagnosis with RDT kits by care givers at the designated clinics and at community levels. The 656 RDT positive children recorded in this study were treated with Artesunate-Amodiaquine. Microscopic slides of the blood of all the children presented for RDT were equally prepared and examined. Another 333 symptomatic children aged 2 months to thirteen years served as control in one clinic. All positive cases were reviewed, seven days after drug administration. Three hundred and nine (309) RDT positive children were followed-up for adherence to treatment regime. Intradermal smear and peripheral blood films were prepared for 59 children previously confirmed to be positive and were examined after treatment. Semi-structured questionnaires were administered to determine the perception of malaria and treatment preference of community. An overall malaria community microscopic confirmatory prevalence of 87.7% was recorded for the children. RDT/community based study recorded a cure rate of 88.2% with a prevalence reduction from 78.1% to 11.8%. There was a significant reduction in the malaria parasitaemia (χ2 = 6.97 p = 0.031). A sensitivity and specificity of 85.62% and 75.73% with confidence interval (C.I.) of [83.08 – 88.15] and [67.45 – 84.01] were recorded for paracheck RDT respectively. The positive predictive values recorded for RDT and presumptive diagnosis by medical laboratory scientists were 96.19 and 91.75 and their negative predictive values were 42.39 and 73.08 respectively. Paracheck RDT was found to have slightly higher K agreement to microscopy than presumptive diagnosis of malaria by medical laboratory scientists (0.458/0.445) Clinic/microscopy based diagnosis followed by administration of Artesunate-Amodiaquine recorded 93.7% cure and significant reduction in malaria parasitaemia was equally recorded (χ2 = 73.62 p = 0.000). The highest prevalence of 91.8% was recorded among the 6-10years age group. Significant difference in malaria prevalence was recorded among the different age groups (χ2 = 7.481 p = 0.024). The highest cure rate (88.5%) was observed among the 6- 10years age group. A record of 88.7% adherence to treatment regime was observed. Sensitivity of 81.03% and 25.86% were recorded for intradermal smear and peripheral blood film respectively. Most respondents (95.7%) preferred being treated by health personnel. Knowledge of malaria, transmission and symptoms of malaria were high. Malaria rapid diagnostic test kits were not in use in any of the health facilities designated for this study. The overdependence on microscopy and presumptive diagnosis does not augur well for health care delivery especially in rural communities. Rapid diagnostic test kits could therefore be deployed by state government for diagnosis followed by treatment of malaria with ACT, particularly artesunate-amodiaquine.