Rapid diagnostic tests (RDTs) have significantly made improvements to the treatment of malaria over the last decade. Unnecessary malaria drug prescriptions showed a declining trend, reflecting a shift towards more appropriate and efficient treatment. However, this may have also prompted a rise in the use of antibiotics.

Benefits and downsides of rapid tests on malaria spread

The World Health Organisation (WHO) strongly endorsed for rapid malaria tests in 2010, across 91 countries in Africa. This was part of the efforts to reduce the overuse of anti-malarial drugs, which could accelerate the emergence of drug-resistant malaria. Today, more than 300 million RDTs are currently in use each year.

RDTs use only one drop of blood and produce results within 15 minutes. It has been a reliable tool to detect evidence of malaria parasites in human blood. This is especially useful in remote areas where access to microscopy services is limited.

Only patients with positive results from a RDT are given malaria drugs. Therefore, this brings down the number in cases like misdiagnoses and false prescriptions. Patients with malaria-free fever are then given alternative medications, instead of malaria drugs.

However, a study found that the number of patients who were given antibiotics have increased. Even more concerning, antibiotics were also dispensed even if these patients were not tested for bacterial infections.

“This surprised us, but we don’t have a lot of insights into why it happens,” expressed Dr Heidi Hopkins, a malaria diagnostics expert at the London School of Hygiene and Tropical Medicine, who is also one of the study’s authors.

Why are malaria patients prescribed with antibiotics more than malarial drugs?

The study, published in The American Journal of Tropic Medicine and Hygiene, found between 40 – 80% of those who did not have malaria were given antibiotics, despite the majority having viral infections that antibiotics are ineffective against.

Ample rest, fluids and a mild fever-reducing drug are usually the best treatment. However, both patients and healthcare providers are not comfortable with this approach.

Antibiotics are offered to these patients, just in case the cause is bacterial. This was found to be the case as complex testing is inaccessible in many of these rural areas.

“We definitely can’t blame them for doing that,” said Dr Hopkins. “Some of these patients are mothers who bring their kids in from 20 kilometers away on motorcycles or in minibuses. You can certainly understand why a health care worker would be reluctant to just send them home with a pat on the head and advice to take paracetamol and drink fluids.”

Tackling the challenges in global health

Antibiotic resistance is accelerated by the misuse and overuse of antibiotics. It is an increasingly serious threat and battling antibiotics resistance has fast become one of our biggest public health challenges.

Some types of bacterial species that cause skin infections, meningitis, sexually-transmitted diseases (STD) and respiratory tract infections like pneumonia, have already become resistant to antibiotics making treatments difficult.

The study also reported good news comes in an observed decline in deaths due to malaria by 60% since 2000, thanks to the effectiveness of malaria drugs. Artemisinin combination therapies (ACTs) have largely contributed to the dramatic drop in malaria deaths globally.

However, experts also cautioned that this could be reversed should ACT-resistant malaria spread across the African continent, which accounts for most of the world’s malaria infections.

The study “provides an unvarnished assessment of why treating a patient who walks into a clinic with a fever remains a complex challenge” in rural areas, asserted Patricia F. Walker, President of the American Society of Tropical Medicine and Hygiene.

“Technology alone cannot solve complex health problems; community and provider education, as well as health system changes, must occur hand in hand to improve patient outcomes,” she adds. MIMS

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