Asian J of Pharm Sci & Tech
Vol 6 | Issue 1 | 2016 | 41-47
This study examined the accuracy of clinical diagnosis and rapid malaria diagnostic test (mRDT) for the prediction of malaria; and the patterns of prescription for febrile underfives in a setting with reduced malaria burden. A quantitative facility based study was carried among 510 febrile underfives attending in primary health facilities of Tanga city. For each underfives referred for laboratory malaria confirmation; fever was measured by a digital thermometer and finger prick blood samples taken
for mRDT testing and microscopy. Results of mRDT were provided to the clinician for a prescription and type of drugs prescribed recorded. Accuracy of measured fever, clinical diagnosis and mRDT for the prediction of malaria was assessed by performance indices against microscopy. Influence of mRDT results on prescribing patterns was also assessed. A clinical malaria diagnosis had a very highly sensitivity (100% [95%CI: 87.0 – 100.0]) and negative predictive value (100.0% [95%CI: 98.7 –100.0]); but a relatively low specificity (74.0% [95%CI: 70.0 – 77.8]) and very low positive predictive value (21.0% [95%CI:15.1 – 28.4]). The mRDT retained very high sensitivity ≥ 95.0% (97.0% [95%CI: 84.2 – 99.5]), specificity was also high (93.9 % [95%CI: 91.4 – 95.9]) but below the WHO recommendation of ≥ 95%. Of the 162 receiving antimalarial, only 21.6% were mRDT positive while majority (78.4%) was mRDT negative. Of those receiving antibiotic, the large majority (93.0%) was mRDT negative probably representing an over prescription of antibiotics. The decline in malaria prevalence has altered the performance of mRDT to a specificity < 95% below the WHO recommendation. There was an over prescription of both antimalarial andantibiotics.
Key words: Febrile underfives, Diagnostic accuracy, mRDT, Prescribing patterns, Tanzania.