The Role of Rapid Diagnostic Tests in Managing Malaria

In recent years malaria treatment policies have shifted in most African countries to artemisinin-based combination therapies (ACT), which are highly effective but also much more expensive than previous regimens [1]. In order to avoid overprescription of ACT, new guidelines from the World Health Organization recommend that a laboratory test should be performed before treating [2]. The widespread introduction of rapid diagnostic tests (RDTs) for malaria allows diagnosis to be made even in health settings lacking any laboratory facility. Since RDTs generally cost less than a full course of ACT, their introduction should not only improve malaria management but should also limit malaria treatment costs. However, recent research has shown that clinicians are reluctant to refrain from treating for malaria after a negative test [3,4]. Clinicians’ adherence to a test-based strategy is a key factor in determining whether the strategy is effective at improving management and curtailing costs [5,6]. If the result of a test is not going to influence management, then doing the test is a waste of money [6]. Moreover, RDTbased policy is usually restricted to adults and older children, while for under-fives presumptive malaria treatment of all fevers is still recommended [2]. This leads to the paradox that the improved diagnostic techniques are of no utility for the group at highest mortality risk.