Rapid diagnostic tests compared with malaria microscopy for guiding outpatient treatment of febrile illness in Tanzania: randomised trial.

摘要: Objective To compare rapid diagnostic tests (RDTs) for malaria with routine microscopy in guiding treatment decisions febrile patients. Design Randomised trial. Setting Outpatient departments northeast Tanzania at varying levels of transmission. Participants 2416 patients whom a test was requested. Intervention Staff received training on tests; sent were randomised to or Main outcome measure Proportion negative prescribed an antimalarial drug. Results Of 7589 outpatient consultations, 2425 (32%) had 1204 microscopy, 1030 (86%) tested malaria; 523 (51%) these treated 1193 test, 1005 (84%) negative; 540 (54%) (odds ratio 1.13, 95% confidence interval 0.95 1.34; P=0.18). Children aged under 5 more likely be drug than those slides (P=0.003). Patients by any method antibiotic 6.42, 4.72 8.75; P Conclusions Although many cases are missed outside the formal sector, within it is massively over-diagnosed. This threatens sustainability deployment artemisinin combination treatment, and treatable bacterial diseases missed. Use tests, basic clinical staff, did not itself lead reduction over-treatment malaria. Interventions improve clinicians9 management illness essential but will easy. Trial registration Clinical trials NCT00146796.