Whilst 2010 recommending diagnostic confirmation prior to treatment

Whilst the AMFm programme has been
successful in improving access to ACTs across the country, they are frequently
prescribed without parasitological confirmation of malaria8,9,13–15. This is despite the WHO Global Malaria Programme releasing revised
guidelines in 2010 recommending diagnostic confirmation prior to treatment of
all suspected malaria cases16,17. The improper use of ACTs not only results in inappropriate
treatment of fever but also increases the selective pressure for resistance in
parasite populations and limits ACT availability for those that require them15,18,19. Given that up to 80% of fevers in Uganda are reportedly treated in
the informal and private sectors 1, there is a lack of access to diagnostic tools 20. Demonstrating this, a 2012 study showed that out of febrile
children receiving treatment in the private sector, only 10.3% were given
appropriate care 8. To ensure proper case management and reduce the overuse of ACTs, there
is an urgent requirement to provide the private sector with the tools to diagnose
potential malarial episodes. Rapid diagnostic tests (RDTs) are a quick,
affordable and accurate way to ensure appropriate treatment, without the need
for special laboratory equipment or extensive training 14.


A study in central Uganda showed that the
implementation of subsidised RDTs was successful in decreasing the use of ACTs,
with the proportion of febrile patients receiving appropriate treatment
increasing from 33.7% to 72.9% 15. In addition to this, behavioural studies looking at the
introduction of RDTs into registered drug shops have shown that clients welcomed
the availability of diagnosis and the drug-vendors embraced the ability to
demonstrate a new technical skill 11. RDTs, by encouraging the use of legal registered drug stores would
also assist in integrating them into the hierarchy of the formal health care
system11,21. Furthermore, the administration of ACTs only to confirmed malaria cases
may help to strengthen the public trust in the drugs and encourage their proper
use 22. It has been demonstrated that the introduction of RDTs into the
private sector in Kampala is feasible and welcomed by the community11,18,23,24. However it has also been shown that the RDTs must be highly
subsidised as the price that a consumer was willing-to-pay was lower than
end-user prices 25. It is clear that improved access to diagnostics in the private
sector will be hugely beneficial for those who have limited access to public
health care facilities 26.

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