When is malaria not malaria?

Two months into using malaria rapid tests, some health facilities in Burkina Faso continue treating for malaria despite negative test results, according to community health workers.



Since June 2009, the government has made available 240,000 rapid malaria tests in half of its 63 health districts, the national anti-malaria programme coordinator, Laurent Moyenga, told IRIN.



In northwestern Burkina Faso, at a district health centre in Ziga, which serves 13 villages with more than 10,000 people, centre director Soumaïla Salembere told IRIN that children who were at least six years of age and suspected of having malaria were given a rapid test.



He told IRIN that if the child had a fever, headache, loss of appetite, or was vomiting, his centre automatically administered malaria treatment even if the test result was negative. "The test result could be a false negative. If the malaria treatment does not work, then we search for another solution."



Moyenga said this treatment was incorrect. "How can health workers decide what is positive and negative? They cannot say a test result is a false negative without saying there are also false positive results."



In a recent World Health Organization (WHO) evaluation of rapid tests, two brands accurately detected malarial parasites 95 percent of the time, but researchers said quality varied depending on the test manufacturer, and storage and transport conditions.



Burkina Faso's malaria policy - in line with WHO recommendations for negative rapid test results - was to research other causes of febrile diseases (those characterized by fever), including meningitis, respiratory infections and typhoid fever, Moyenga told IRIN. But he also admitted that not all health facilities had the equipment to diagnose typhoid fever.



David Bell, a scientist at the Geneva-based non-profit Foundation for Innovative New Diagnostics, told IRIN that new approaches were needed to diagnose febrile diseases in addition to malaria.



"There needs to be a lot of investment in diagnostics appropriate for this [community] level to guide health workers to at least identify and treat, or refer, those patients who have a non-malarial infection that is likely to kill them. Most African children who die have diseases other than malaria."



According to WHO, the deadliest childhood illnesses worldwide are malaria, pneumonia and diarrhoea.



In 2008 Burkina Faso had three million officially reported cases of malaria with a 2 percent mortality rate, but it was not clear how many of these were in fact malaria. "We will analyze rapid test results and the number of malaria treatments administered to learn the true disease burden," Moyenga said.



When asked whether his analysis might be skewed by health centres treating suspected but unconfirmed cases as malaria regardless of the rapid test results, Moyenga said the situation would change.



"Health workers are undergoing training about the tests. Rapid tests are still relatively new here ... health workers still automatically treat for malaria, and this will take time to change."



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