TY - JOUR
T1 - Integrated community case management of fever in children under five using rapid diagnostic tests and respiratory rate counting
T2 - A multi-country cluster randomized trial
AU - Mukanga, David
AU - Tiono, Alfred B.
AU - Anyorigiya, Thomas
AU - Källander, Karin
AU - Konaté, Amadou T.
AU - Oduro, Abraham R.
AU - Tibenderana, James K.
AU - Amenga-Etego, Lucas
AU - Sirima, Sodiomon B.
AU - Cousens, Simon
AU - Barnish, Guy
AU - Pagnoni, Franco
PY - 2012/11
Y1 - 2012/11
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84875502548&partnerID=8YFLogxK
U2 - 10.4269/ajtmh.2012.11-0816
DO - 10.4269/ajtmh.2012.11-0816
M3 - Article
C2 - 23136274
AN - SCOPUS:84875502548
SN - 0002-9637
VL - 87
SP - 21
EP - 29
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
IS - SUPPL.5
ER -