as RPTs are being scaled up in Africa, efforts are being made to educate health workers about the appropriate use of the test and the patient to know that a negative test from an RDT means you do not have malaria. It does not mean you are not ill. It just means you do not have malaria."

Rima Shretta is a senior program associate for Management Sciences for Health in Arlington, Virginia. She says her group is interested in collecting data on the way African health workers use the tests. However, she notes that the World Health Organization recommends that one group does not need to be treated with RDTs, but can be treated with just a clinical diagnosis: children under five living in high malaria transmission areas with symptoms such as fever. She says they are among the most vulnerable to the disease and that it’s very likely that malaria is the cause of their current fever. For that reason, she says it’s not cost effective to spend the money on rapid diagnostic tests.

The mortality rate for children under five is high," she says, "and [there is the] likelihood [that these children’s] have malaria if their fever is quite high. [There is a probability that they will have malaria which may progress very rapidly to severe disease in the absence of treatment due to low levels of immunity]. In areas with no RDTs what they recommend is that clinical diagnosis [based on observed symptoms] -- which had been the cornerstone for children under five -- continue to be used as opposed to RDTs because there is a high likelihood they will have malaria anyway. Guidelines on the integrated management of childhood illnesses (imci) recommend that fever be used as a proxy for malaria.

Shretta says her organization is also assessing the supply chain to ensure the quality of the test kits, which must be stored in temperatures lower than 30 degrees Celsius to maintain their accuracy and reliability. Meanwhile, the WHO is compiling data that hel
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