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Malaria diagnosis: Moving from a mess to an ordered programme to a tool for elimination The All-Party Parliamentary

2. Malaria Diagnosis, WHO 2009. Prompt parasitological confirmation by microscopy or alternatively by RDTs is recommended in all patients suspected of malaria before treatment is started. Treatment solely on the basis of clinical suspicion should only be considered when a parasitological diagnosis

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Malaria diagnosis: Moving from a mess to an ordered programme to a tool for elimination The All-Party Parliamentary

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    1. 1 Malaria diagnosis: Moving from a mess to an ordered programme to a tool for elimination The All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases (APPMG) David Bell FIND Nov 2009

    2. 2 Malaria Diagnosis, WHO 2009 Prompt parasitological confirmation by microscopy or alternatively by RDTs is recommended in all patients suspected of malaria before treatment is started. Treatment solely on the basis of clinical suspicion should only be considered when a parasitological diagnosis is not accessible.

    3. 3 Confirmation of diagnosis % confirmation of parasitaemia in suspected malaria cases

    4. 4 Magnitude of over-diagnosis /over-treatment

    5. 5 Changing case management Management of febrile illness

    6. 6

    7. 7 RDT impact, Zambia

    8. 8

    9. 9 Senegal Parasite prevalence of malaria-like fever cases

    10. 10 Weekly Malaria Lab. Tests, 2008, Kabale District: Uganda Saving costs by treating only lab confirmed case!

    11. 11

    12. 12 Challenges to implementing comprehensive RDT-based diagnosis Sensitivity e.g. 20% to 99% in published studies Stability Recommended storage temperature often inappropriate for rural health clinic in tropics (e.g. <35°C) User safety Blood safety (gloves, sharps disposal, HIV risk) Programmatic Managing negative results (non-malaria fever patients) Logistics Monitoring

    13. 13 Building a structured diagnostics programme

    14. 14 Selecting RDTs for procurement. WHO Product Testing Round 1: 2008-9

    15. 15

    16. 16 WHO-FIND Laboratory network

    17. 17 Innovative planning, infrastructure and training

    18. 18

    19. 19 Minimum standard for funding a programme?

    20. 20 In the pipeline 2010-2011: Country based lot-testing, clinic-based QC testing Recombinant antigen-based testing panels for RDTs: Moving control of quality control to national programmes, and health workers, in endemic countries Harmonizing standards and RDT detection thresholds between developers, manufacturers and users

    21. 21 Towards elimination: Detection of P. falciparum ‘reservoir’

    22. 22

    23. 23 Potential for high through-put LAMP-based screening

    24. 24 Accurate diagnosis at community level: Effort and outcomes

    25. 25 WHO FIND HTD, UK RITM, Philippines IP, Cambodia US CDC AMI, Australia MSF DMR, Myanmar IP, Madagascar IP, Central African Republic IHDRC, Tanzania KEMRI, Kenya EHNRI, Ethiopia Uni Lagos, Nigeria UCAD, Senegal CIDEIM, Colombia IMT, Peru Zambia NMCC Uganda MoH URC Malaria Consortium NBI, South Africa BMGF USAID/Asia USAID/Deliver AusAID Manufacturers

    26. 26 Addressing microscopy performance

    27. 27 Introduction of a slide validation programme (MSF, Sudan)

    28. 28 Addressing microscopy performance

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