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Global Health: Rapid Malaria Tests Work, but With Unexpected Drawbacks

Drug shortages were uncommon at most study sites, she said. But it is also possible that nurses inured to shortages might have held back free drugs from patients who were not seriously ill or who appeared able to buy the drugs elsewhere.

The study, published in The American Journal of Tropical Medicine and Hygiene, looked at more than 500,000 patient visits to rural or urban clinics in five African countries and Afghanistan.

Over all, 75 percent of the patients got malaria drugs or an antibiotic, regardless of their test results.

In most sites, between 40 to 80 percent of those who did not have malaria got antibiotics, even though the majority probably had viral infections, which antibiotics do not help. The best treatment is usually rest, fluids and a mild fever-reducing drug.

One advanced study in Zanzibar looking into all causes of fever found that only about 22 percent were bacterial, Dr. Hopkins said. But complex testing in poor countries is impossible, so doctors and nurses often offer antibiotics to sick patients just in case the cause is bacterial.

“We definitely can’t blame them for doing that,” Dr. Hopkins said. “Some of these patients are mothers who bring their kids in from 20 kilometers away on motorcycles or in minibuses. You can certainly understand why a health care worker would be reluctant to just send them home with a pat on the head and advice to take paracetamol and drink fluids.”

The study was part of a long effort paid for by the Bill and Melinda Gates Foundation to investigate how artemisinin, a malaria drug invented in China and introduced about 15 years ago, could be widely used — but not overused.

Malaria experts hope to slow down the emergence of artemisinin-resistant strains. Deaths from malaria have dropped 60 percent since 2000, partly because the drugs are so effective — but resistant parasites are turning up, especially in Southeast Asia.

In 2010, the World Health Organization strongly endorsed rapid malaria tests, and now more than 300 million are used each year.

Although the ideal way to diagnose malaria is still to examine stained blood under a microscope, many clinics lack microscopes and trained staff.

Source: NYT > World

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