Background
Methods
Search methodology
Selection of studies
Data extraction
Analysis
Results
Search results
Risk of bias summary
RDT performance when used by CHWs
Study | Target population | RDT type | Reference standard (RS) | RS positive* (%) | Sensitivity (%) | Specificity (%) |
---|---|---|---|---|---|---|
Ratsimbasoa[29] | >2 months (history of) fever | CareStart | PCR | 56.7% | 61.8% | 95% |
Ratsimbasoa[29] | >2 months (history of) fever | CareStart | Microscopy of thin and thick BS | 37.2% | 95.9% | 87% |
Chinkhumba[30] | >5 years (history of) fever | Bioline SD, First Response malaria, Paracheck PF | Microscopy of thick BS (expert) | 38.5% | 95% | 43% |
>5 years (history of) fever | Bioline SD | Microscopy of thick BS (expert). | 41% | 97% | 39% | |
>5 years (history of) fever | First response malaria | Microscopy of thick BS (expert). | 40% | 92% | 42% | |
Ishengoma[28] | All ages, care seeking | Paracheck Pf, ParaHIT | Microscopy of thick and thin BS. | 20.8% | 88.6% | 88.2% |
Ishengoma[28] | < 5 years | Paracheck Pf, ParaHIT | Microscopy of thick and thin BS | 19.7% | 90.1% | 93.6% |
Ishengoma[28] | ≥5 years | Paracheck Pf, ParaHIT | Microscopy of thick and thin BS | 21% | 88.3% | 86.5% |
Ishengoma[28] | No fever patients | Paracheck Pf, ParaHIT | Microscopy of thick and thin BS | 14.5% | 84.7% | 90.1% |
Ishengoma[28] | Fever patients | Paracheck Pf, ParaHIT | Microscopy of thick and thin BS | 33.9% | 92.2% | 82.9% |
>3 months suspected of malaria | Paracheck Pf | Microscopy of thick BS. | 18.7% | 88.7% | 94.2% | |
>3 months suspected of malaria | Parascreen | Microscopy of thick BS. | 18.7% | 83.2% | 95.1% | |
Mubi[24] | >3 months (history of) fever. | Paracheck Pf | Microscopy of thick BS. | 22.6% | 85.3% | 59.8% |
Premji[31] | Children <42 months | Parasight TM-F test | Microscopy of thin and thick BS. | 66.6% | 84% | 81% |
Tiono[14] | Children 6–59 months with (history of) fever. | FirstSign Malaria Pf | Microscopy of thin and thick BS. | 54.8% | 97.9% | 53.4% |
Tiono[14] | Children 6–59 months with (history of) fever. (High transmission) | FirstSign Malaria Pf | Microscopy of thin and thick BS. | 76.1% | 98% | 25.4% |
Tiono[14] | Children 6–59 months with (history of) fever. (Low transmission) | FirstSign Malaria Pf | Microscopy of thin and thick BS. | 31.8% | 97.6% | 63.7% |
RDT interpretation
Study | CHW training | Outcome interpretation | Outcome execution |
---|---|---|---|
Counihan[18] | Half-day training. At 3 months CHWs received a poster-sized job aid and a photographic guide on RDT interpretation. | (I) RDT test results correctly read by 95.1, 98.3 and 98.3% of the CHWs at 3, 6 and 12 months after training respectively. | 19-item checklist, interpretation included, 8 items were considered critical. |
(II) Correct interpretation of positive RDT results was 96.5% at 3 months, 98.3% at 6 months and 90.5% at 12 months. | Median correctly performed critical steps were 87.5%, 100% and 100% at 3, 6 and 12 months respectively. | ||
(II) Correct interpretation of negative RDT results was 94.3% at 3 months, 97.9% at 6 months and 94.7% at 12 months. | 40.3, 61.7 and 79.7% of CHWs correctly performed critical RDT steps at 3, 6 and 12 months respectively. | ||
(II) Faint positive lines were correctly interpreted by 89.7% at 3 months, 96.7% at 6 months and declined to 76.7% at 12 months. | |||
Mukanga[32] | 8-day training by experienced trainers. Job aid provided. | 100% of the RDTs were correctly interpreted shortly after training (<2 weeks). | 96.3% of RDTs were correctly performed shortly after training (<2 weeks) in a 14-item checklist, interpretation excluded. |
Harvey[19] | Group 1: only use of manufacturers’ instructions. Group 2: only use of job aid. Group 3: 3- hour training on RDTs + job aid. | (I) 72, 86 and 96% of CHWs correctly interpreted RDT results for group 1, 2 and 3 respectively. | 57% of steps, 80% of steps and 90% of steps were correctly performed by group 1, 2 and 3 respectively at the same day of receiving instructions, job aid or training in a 16-item checklist, interpretation included. |
(II) 54, 82 and 93% of tests were correctly interpreted for group 1, 2 and 3 respectively. | |||
Hawkes[21] | One day training. Pictorial job aid was provided. | 100% of CHWs correctly interpreted the RDT directly after training. | Median score on a WHO 16-item assessment of RDT performance was 100% (range of 94-100%) directly after training. |
Ndiaye[20] | CHWs: one month theoretical training, one month practical training at health post. CMDs: 3-day theoretical training, 15 days practical training at health post. | - |
% CHWs and CMDs correctly performing the step, observed over two years.
|
(1) Surface clean and flat - 87% | |||
(2) Test opened just before use - 100% | |||
(3) Document patient name and date - 83% | |||
(4) Use of gloves - 0% | |||
(5) 5 μL finger prick blood specimen - 93% | |||
(6) 4 drops of solution buffer in right well - 93% | |||
(7) test rest on level surface - 97% | |||
(8) waited maximum 15 minutes - 93% | |||
Mubi[24] | One week training. | 99.7% of positive tests were correctly interpreted throughout the 5-month study period. | - |
Execution of RDTs
Adherence to test results and referral guidelines by CHWs
Study | Target population | Treatment | Alternative | Adherence overall* | Positives treated | Negatives treated |
---|---|---|---|---|---|---|
CCMm studies
| ||||||
All ages, care seeking. | AL, SP <5 kg | Complicated malaria and non-malaria febrile cases were referred to HF. | 99.9% | 99.3% | 0.2% | |
Chinkhumba[30] | >5 years, (history of) fever | NS | Referral not mentioned. | 86.9% | 98% | 58% |
Elmardi[27] | NS | AS/SP | Complicated malaria and non-malaria febrile cases were referred to HF. | 70%** | NS | NS |
Ishengoma[28] | ≥5 years with (history of) fever | AL | Referral not specified. | 95.8% | 98.9% | 5.4% |
Mubi[24] | >3 months, (history of) fever. Exclusion: severe disease | AL | Referral not specified. | 96.8% | 99.7% | 6.1% |
Patients of all ages, care seeking. | NS | CHW: referral of patients <2 months, RDT negatives, severe symptoms, suspected drug adverse events. CMD: referral of all cases excluding uncomplicated malaria cases. | 88.6% | 92.0% | 20.3% | |
Patients of all ages, care seeking. | NS | CHW: Referral of patients <2 months, RDT negatives, severe symptoms, suspected drug adverse events. | 85.6% | 90.1% | 24.8% | |
Patients of all ages, care seeking. | NS | CMD: Referral of all cases excluding uncomplicated malaria cases. | 93.9% | 95.3% | 10.4% | |
iCCM studies
| ||||||
Children 6 months-5 years, fever. | AL | Children with danger signs were referred to HF. | 99.3% | 98.5% | 0.4% | |
Mukanga[32] | Children <5 (history of) fever no danger signs. | AL | CHWs also diagnosed and treated pneumonia. No referral mentioned. | 97.8% | 98.6% | 4.8% |
BF: 6–59 months, (history of) fever | AL | Referral for severe disease and for non-responders at day 3 after CHW visit. | 99.0% | 100% | 4.8% | |
Gh: 6–59 months, (history of) fever | AA | Referral for severe disease and for non-responders at day 3 after CHW visit. | 99.5% | 100% | 3.3% | |
Ug: 4–59 months (history of) fever. | AL | Referral for severe disease and for non-responders at day 3 after CHW visit. | 99.0% | 99.9% | 7.6% |
Morbidity and mortality
Study | Design | Intervention | Control | Outcome |
---|---|---|---|---|
Mubi[24] | RCT | RDT-based CCMm | Presumptive CCMm | Increased perception of recovery in control group (97.3%) versus intervention group (93.3%) at day 7. P = 0.000 |
Two malaria related deaths, one in each arm. | ||||
Thiam[25] | NRCT | RDT-based CCMm | No CCMm | Malaria related hospitalizations decreased by 43.1% in intervention areas and 40.9% in control areas. Malaria attributed deaths decreased by 62.5% in intervention areas (significant decrease) and 23.4% in control areas (no significant decrease). |
Rutta[26] | Pre-post study | RDT-based CCMm (with AL) | Comparison with pre-intervention period (presumptive CCMm with SP) | A drop of >72.0% in malaria slide positivity rate to a persistent low level of <10% was observed in the study period. |
Elmardi[27] | Pre-post study | RDT-based CCMm (with AS/SP). | Comparison with pre-intervention period (no CCMm, health centres treated with AS/SP) | 24% fever cases in last two weeks pre-intervention and 8.5% fever cases post intervention (p = 0.000). |
61 deaths (all <5 years) in the last season pre-implementation of intervention versus 1 death (>5 years) in the season post-implementation (p = 0.000). |
Community acceptance
Uptake of RDT based CCMm by members of the community
Study | Intervention | Control | Outcome |
---|---|---|---|
Elmardi[27] | RDT-based CCMm | Comparison with pre-intervention period (no CCMm) | Pre-intervention 25% of mothers of sick children <5 years would seek care within the village, after the study 64.7% would seek care within the village (p value). |
Lemma[40] | RDT-based CCMm | Presumptive CCMm | Only half the number of patients (5,123 patients) visited CHWs who performed RDT-based CCMm compared with presumptive CCMm (10,475 patients). |
Tayler-Smith[15] | RDT-based CCMm free of charge | Health centre care, little payment was required for ACT. | In two years there was an increase in number of episodes of treated malaria per child per year from 0.4 to 1.2 for CHWs, whereas it remained stable at 0.2 for health centres. |
Stock-outs
Motivation and remuneration of CHWs
Cost-effectiveness
Study | Intervention | Control | Malaria prevalence | Outcome |
---|---|---|---|---|
Hawkes[21] | RDT-based CCMm for ≥5-14 years, presumptive <5 years old. | Presumptive treatment up to 14 years old. | 88% by microscopy, for calculations prevalence of 80% was considered. | 8.79 US$ for each case saved from unnecessary treatment (total health budget per person per year is 15$). Total costs three times as high for RDT based CCMm. |
Lemma[22] | RDT-based CCMm for P. falciparum with AL, other febrile cases treated with CQ. | Two comparisons. 1. RDT-based CCMm for P. falciparum (AL) and P. vivax (CQ) and referral of all others. | Slide positivity rate 27.29%, of which 70% P. falciparum. | Intervention: 4.66 US$ per correctly treated case. |
Control 1. 1.69 US$ per correctly treated case. | ||||
Control 2. 11.08 US$ per correctly treated case. | ||||
2. Presumptive treatment with AL for all fever patients. | ||||
Total costs were lowest for intervention strategy. | ||||
Chanda[23] | RDT-based CCMm with AL for all age groups (free of charge) | Health centre-based care (free of charge) | Prevalence 24% in RDT-based CCMm and 26% in health centres, either by RDT or microscopy. | Cost per case appropriately diagnosed and treated 4.22 US$ in RDT based CCMm (mainly because of higher adherence) and 6.61 US$ in health centers. Additional cost per change in case appropriately diagnosed and treated was 4.18 US$. |