Malaria
One challenge of using intermittent screening and treatment is getting adequate supplies of rapid diagnostic tests
screening with RDT is likely to identify most infections in pregnant women and out-performs microscopy as a diagnostic tool.’ Likewise, researchers in Uganda found RDTs more sensitive than microscopy.5
The challenge remains to
convince health workers of the validity of RDTs, espe- cially if these are to become the basis of a new interven- tion to protect pregnancy women from malaria’s burden. Researchers have suggested an active detection and case management process using ANC as a platform – intermittent screening and treatment (IST). One of the earliest allusions to IST was in a 2008 study in Ghana, where the researchers concluded that RDTs fit eas- ily into ANC procedures and outlined the benefits of ‘antenatal RDT screening and treatment.’6
One of the
researchers actually used the term IST during a presenta- tion on malaria intervention options for Asia at the 11th meeting of the Roll Back malaria Partnership’s Malaria in Pregnancy Working Group in 2008.7 In 2010, the same research team again reported from Ghana on comparing IPTp during ANC with IST using two different drug regimens.8
All three arms showed a
reduction of parasitemia near the end of their pregnan- cies, but with the benefit of reduced drug use in the two IST arms. One might note in addition that while IPTp is not used in the first trimester due to potential effects of SP on the foetus, IST could be practiced on a woman’s first ANC visit, even if it were in the first trimester since quinine is approved for treatment during that period if the RDT is positive. Research continues on IST. Rwanda has recently completed a malaria in pregnancy prevalence study using RDTs and treatment of those with parasitemia dur- ing first ANC visit and is in the process of determining guidelines for formalising this as part of ANC. Unicef in collaboration with USAID is piloting IST in selected regions of Indonesia.9
34 Africa Health
Health staff in Rwanda have shown the feasibility of using rapid diagnostic tests in antenatal care and then prescribing appropriately
IST appears to work where there a platform for deliv- ering the service. School based studies of IST in Kenya have yielded encouraging results.10
did conclude with a caveat that the complexity of the intervention would have to be reduced to make it more cost-effective. Parents and other stakeholders in Kenya seemed to accept IST in the classroom, but raised some issues about involving the teachers.11
Since front line
health staff and village health workers can perform RDT correctly, there is no reason why classroom teachers can also perform the test and provide the treatment. Practical issues of integrating the RDT testing and
ACT provision need to be addressed including funding and procurement processes to ensure adequate supplies at ANC. IST will require greater health systems capacity
The Kenyan experience
Studies show that intermittent screening and treatment may be possible in schools
July 2012
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68