Malaria Rapid Diagnostic Tests Reduce Child Mortality in Sub-Saharan Africa: JAMA

A recent study published in the Journal of American Medical Association highlighted the significant impact of point-of-care malaria rapid diagnostic tests (RDTs) in improving the management of febrile illnesses and reducing mortality among children under 5 years of age in sub-Saharan Africa. This study analyzed the association between the widespread distribution of malaria RDTs and healthcare outcomes across 35 sub-Saharan African countries with the data from 165 nationally representative household surveys conducted between 2000 and 2019.

The study utilized a comprehensive dataset consisting of 3.9 million child-year observations and approximately 260,000 episodes of febrile illness among children under 5. This research assessed how the distribution of malaria RDTs affected key outcomes such as blood testing rates, the use of antimalarial drugs, antibiotic prescriptions, symptomatic treatments, and child mortality. This study applied fixed-effects linear probability models to examine the variations in RDT distribution per child, year-by-year and country-by-country by correlating this data with healthcare practices and mortality trends.

The results showed a clear association between increased RDT distribution and improved clinical management of febrile illnesses in children. For every additional malaria RDT distributed per child, there was a 3.5 percentage point increase in blood testing rates (95% CI, 3.2-3.8 points). This improvement in diagnostic practices was accompanied by a 1.5 percentage point rise in antimalarial drug use (95% CI, 1.2-1.8 points) and a modest 0.4 percentage point increase in antibiotic use (95% CI, 0.1-0.6 points). The use of symptomatic treatments like fever reducers or pain relievers were slightly declined up to 0.4 percentage points (95% CI, 0.1-0.8 points) per additional RDT distributed.

This study found that the expanded availability of RDTs was associated with a 0.34 reduction in child deaths per 1,000 child-years (95% CI, 0.15-0.52). These survival benefits were most notable in regions with high malaria prevalence by suggesting that RDTs are particularly effective in settings where malaria is a common cause of febrile illness.

While the findings are promising, the study also observed an increase in antibiotic use which raises the concerns about antibiotic overuse. The widespread prescription of antibiotics, even in cases where malaria was confirmed, indicates the need for more comprehensive approaches to febrile illness management. Overall, the increased distribution of malaria RDTs has significantly improved diagnostic accuracy, antimalarial drug use, and child survival rates in sub-Saharan Africa. Further dedicated efforts are needed to ensure that the treatment of febrile illnesses is optimized and unnecessary antibiotic use is minimized.

Reference:

Zhang, H., Fink, G., & Cohen, J. (2024). Malaria Rapid Tests, Febrile Illness Management, and Child Mortality Across Sub-Saharan African Countries. In JAMA. American Medical Association (AMA). https://doi.org/10.1001/jama.2024.12589