Another challenge is the possibility of false-negative results due to low levels of parasitaemia. A false-negative mRDT result could cause delay in the initiation of treatment.

In children, this could lead to severe malaria, with possible disability or death.39 In a move to address this problem, WHO has recently adjusted the panel detection score in its program of RDT evaluation from 50% to 75% for P. falciparum in areas of high transmission.53 This move further raises the standards required of commercially-produced RDTs. At present there is no local production of mRDTs in Ghana. As such all the RDTs that are used in the country are imported. Those that the Ministry of Health in Ghana imports are pre-qualified by the WHO and guaranteed to be of good quality. However the liberal trading regime in Ghana means that mRDTs enter the country through other sources and may not be monitored. It is important

for regulatory authorities to be Selleckchem GSK1349572 alert to the high possibility that sub-standard mRDTs could be imported into the country and into clinical use.54 Currently, there are proposals at WHO for the development of kits that clinicians can use to check the quality of mRDTs at point-of-care.55, 56 Until these become available however, clinicians and health facilities will still need to be careful about the brands of mRDTs that they procure for use in clinical care. Ensuring health workers adhere to mRDT results and CHIR-99021 research buy restrict to only positive cases A major factor affecting effective implementation of health interventions in sub-Saharan Africa is the attitude of health workers. Inadequate health-worker performance is a very widespread problem and experience has shown that adherence to clinical guidelines is often low.57 The cost-effectiveness of implementing

test-based management of malaria hinges on health workers Methisazone adhering to test-results and restricting ACTs to test-positive cases while looking for other causes of fever in the test-negative cases. The concern that health workers may not adhere to test-results is largely founded on the use of smear microscopy in clinical care in the past. Many clinicians and other health workers in malaria-endemic countries treat patients with antimalarials even after receiving negative parasitological test results.58 The rate at which clinicians across sub-Saharan Africa have ignored negative test results and prescribed antimalarial have ranged from 50% to 90%.59, 60 58 Emerging evidence suggests, however, that once clinicians gain confidence with the use of test-based management and find a correlation between the results of the test and clinical outcome, adherence to test-results improves. In Senegal test-based management of malaria using RDT was incorporated into national policy in September 2007. In the first year following implementation, the RDT-positive rate lagged well behind ACT consumption and this was attributed to health worker non-adherence to test results.