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  • PA-55 Two-step malaria RDT detection PfHRP2/pLDH and point-of-care tests for bacterial infections for the management of febrile diseases in children under-5 years in Burkina Faso

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PA-55 Two-step malaria RDT detection PfHRP2/pLDH and point-of-care tests for bacterial infections for the management of febrile diseases in children under-5 years in Burkina Faso
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  1. Francois Kiemde1,
  2. Fla Koueta2,
  3. Athanase M Some1,
  4. Daniel Valia1,
  5. Berenger Kabore1,
  6. Toussaint Rouamba1,
  7. Seydou Sawadogo1,
  8. Macaire Nana3,
  9. Diane Y Some1,
  10. Nadine A Kone1,
  11. Adelaide Compaore1,
  12. Antonia W Bere1,
  13. Massa dit Achille Bonko1,
  14. Gautier Tougri4,
  15. Sylvie Yeri Youl5,
  16. Henk Schallig6,
  17. Halidou Tinto1
  1. 1Institut de Recherche en Sciences de la Santé – Clinical Research Unit Of Nanoro (IRR-CRUN), Burkina Faso
  2. 2Department of Pediatrics – CHU Yalgado Ouedraogo, Burkina Faso
  3. 3Health District of Nanoro, Ministry of Health, Burkina Faso
  4. 4National Malaria Control Program, Ministry of Health, Burkina Faso
  5. 5National Agency for Primary Healthcare, Ministry of Health, Burkina Faso
  6. 6Amsterdam University Medical Centers, Academic Medical Centre at the University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Laboratory for Experimental Parasitology, Amsterdam Institute for Infection and Immunity, The Netherlands

Abstract

Background In low and middle incomes countries such as sub-Saharan Africa, the management of febrile diseases remains challenging given the lack of practical diagnostic tools to screen the real cause of fever and the limits of malaria rapid diagnostic tests. In order to improve the management of febrile diseases in children under 5 years, this study has been conducted.

Methods The study was conducted at the Field Station of Sigle, set-up by the Clinical Research Unit of Nanoro. All patients from 6–59 months attending the outpatient clinic of the health facility of Bologho in the health district of Nanoro, with documented fever or history of fever within the pass 7 days were invited to participate to the study. Participants were randomized either the intervention package (e-Algorithm or RDT-decisional algorithm arm(RDT-DA)) or routine system. The intervention package was constituted by the following PoC tests: two-step malaria RDT detection PfHRP2 and pLDH, CRP, white blood cells (WBC) count, oximetry, Group A Streptococcus, and Salmonella/Shigella.

Results Antimalarial prescription was 42.05% (164/390) in e-Algorithm arm, 43.65% (172/394) in RDT-DA and 52.30% (232/392) in standard practice system [risk difference (RD): -10.25% (p p<0.001) for e-Algorithm and -8.65% (p<0.001) for RDT-DA). Antibiotics were prescribed in 46.92% (183/390) in e-Algorithm arm, 50.25% (198/394) in RDT-DA arm and 76.28% (299/392) in routine system [RD: -29.36% (p<0.001) for e-Algorithm and -26.03% (p<0.001) for RDT-DA]. The reduction of antibiotic prescription greater in children without malaria [RD:-64.79% (p<0.001) for e-Algorithm arm and -61.62% (p<0.001) for RDT-DA algorithm arm].

Conclusion Implementation of two-step malaria RDT and PoC tests for bacterial infections has potential to improve the management of febrile diseases in children under 5 years and reduce inappropriate prescription of antibiotics. Nevertheless, the use of CRP test is not suitable differentiate bacterial to non-bacterial infections in children with malaria.

https://doi.org/10.1136/bmjgh-2023-EDC.72

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