Project Title

Development and evaluation of an electronic algorithm using a combination of a two-step malaria rapid diagnostic test detecting PfHRP2 and pLDH, and other rapid diagnostic tools for the management of febrile illness in children under 5 years attending outpatient facilities in Burkina Faso (e-MANIC)

EDCTP Project Call

Career Development Fellowship (CDF)

Project Objectives

Primary objective 1: To assess in randomised superiority diagnostic trial the favourable outcomes whether the RDTs decisional algorithm (RDT-DA), e-Algorithm or routine system allow to access to quality health care health at primary health facilities favourable outcomes after treatment. Primary objective 2: To assess the impact of the proposed strategies on the antimalarial and antibiotic prescription practices at primary health facilities

Study Design

Three-arm randomised controlled diagnostic trial

Project Summary

In Sub-Saharan Africa (SSA), febrile illnesses remain a major public health problem in children. The introduction of malaria rapid diagnostic tests (RDTs) in routine healthcare has greatly improved the management of malaria. However, despite the good attitude of healthcare workers to adhere to malaria RDT results, persisting hrp2 antigen and low sensitivity of pLDH RDT negatively affect antimalarials and antibiotics prescription practices. These limitations of the RDTs lead to poor management of febrile diseases and antimicrobial resistance (AMR). To improve the diagnosis of these febrile diseases and subsequent prescription of antimicrobials, it is hypothesized that the implementation of an algorithm including a two-step malaria RDT PfHRP2/pLDH combined with point-of-care (PoC) tests for C-reactive protein (CRP), white blood cells (WBC) count, urine dipstick, oximetry, and bacterial infection such as Group A Streptococcus, and Salmonella/Shigella, will significantly improve the management of febrile diseases and thereby tackling AMR. The current project aims to evaluate the value of the diagnostic performance of the proposed algorithm combining two-step malaria RDT detecting PfHRP2/pLDH and POCT for the diagnostic of malaria and bacterial infections respectively, in the management of febrile illnesses in children from 6 to 59 months old. To achieve these aims, the following primary and secondary objectives will be investigated using clinical, biomedical and social science research through an algorithm based on integrated management of childhood illness (IMCIs) supported by point-of-care (PoC) tests: Primary objective 1- To assess the impact of the proposed strategies on acute fever management practices at primary health facilities; 2- To assess the impact of the proposed strategies on the antimalarial and antibiotic prescription practices at primary health facilities; 3- To assess the curative rate of each arm (RDTs decisional algorithm (RDT-DA), e-Algorithm or routine system) and to determine which one allow to access to quality health cares at primary health facilities. Secondary objectives 1- To assess the accuracy of the algorithm based on (i) two-step malaria RDT detecting PfHRP2/pLDH for the diagnosis of malaria infection compared to microscopy and polymerase chain reaction (PCR); (ii) and POCT for the diagnostic of bacterial infections compared to bacterial cultures. 2- To assess the adherence of health care workers and parents/guardians to the algorithm proposed; 3- To assess the adherence of the health care workers and parents/guardians to the prescription in RDT-DA, e-Algorithm, and control arms; 4- To assess the safety of the algorithm in the management of febrile cases in children presenting in outpatient clinic. A total of 1176 participants have been recruited and randomized into three arms (392 per arm): e-Algorithm, decisional algorithm, and control. During the reporting period, participant recruitment was completed and the preliminary data presented at international conferences. In addition, monitoring visits and project management committee meetings were organized. Two MSc students and 2 PhD students have been successfully trained in this project, and some have been integrated into research team at CRUN. Although the COVID-19 pandemic impacted many research activities worldwide, it did not significantly impact the progress of the e-MANIC project. The project’s progress was delayed due the delay in the enrolment of the first participant and the data analysis. The overall conclusion is that health care can be improved by implemented PoC tests and subsequently reduce inappropriate prescription of antimicrobial. This reduction can be more important if the thresholds of CRP and WBC can be set-up for the study area before implementation. The next step of the project will be the dissemination and reporting to local and national stakeholders

Host Organisation

Current Organisation

Institut de Recherche en Sciences de la Santé-Clinical Research Unit of Nanoro

Current Job Title

Senior Research Staff Member

Biography