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Integrated Community Case Management of Fever in Children under Five Using Rapid Diagnostic Tests and Respiratory Rate Counting: A Multi-Country Cluster Randomized Trial

Author: 

Mukanga, David

Publication: 

Am. J. Trop. Med. Hyg.

Page(s): 
21-29

Evidence on the impact of using diagnostic tests in community case management of febrile children is
limited. This effectiveness trial conducted in Burkina Faso, Ghana, and Uganda, compared a diagnostic and treatment
package for malaria and pneumonia with presumptive treatment with anti-malarial drugs; artemisinin combination
therapy (ACT). We enrolled 4,216 febrile children between 4 and 59 months of age in 2009–2010. Compliance with the
malaria rapid diagnostic test (RDT) results was high in the intervention arm across the three countries, with only 4.9%
(17 of 344) of RDT-negative children prescribed an ACT. Antibiotic overuse was more common: 0.9% (4 of 446) in
Uganda, 38.5% (114 of 296) in Burkina Faso, and 44.6% (197 of 442) in Ghana. Fever clearance was high in both
intervention and control arms at both Day 3 (97.8% versus 96.9%, P = 0.17) and Day 7 (99.2% versus 98.8%, P = 0.17).
The use of diagnostic tests limits overuse of ACTs. Its impact on antibiotic overuse and on fever clearance is uncertain.

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