A cluster-randomised trial of health worker and community interventions to improve adherence to national guidelines for the use of ACTs in Tanzania

It is common practice in Africa to overdiagnose malaria, meaning that very often patients are given ACT drugs simply because they present fever. Given the high price of this type of medication, this approach becomes unsustainable. At the same time, it means that patients don’t receive treatment for their actual illness. Faced with this problem, the World Health Organization introduced revised guidelines for malaria diagnosis and treatment in 2010. Antimalarial treatment should be restricted to patients whose malaria diagnostic result was positive (either through a blood slide or rapid diagnostic test). The National Malaria Control Programme in Tanzania has adopted these recommendations alongside the national scale-up of rapid diagnostic test distribution. Several studies have now documented two primary problems with rapid diagnostic tests. Firstly, health workers frequently prescribe malaria drugs to patients whose test came negative. Secondly, although tests are available, staff continue to diagnose patients based on their symptoms only. Because of their accuracy, rapid diagnostic tests are a potential cost-effective solution for malaria overdiagnosis. However, this method only works if health professionals are trained and supervised.

The TACT trial is an intervention in 36 health facilities that may be useful in improving both the management of malaria cases and the treatment of other diseases that also cause fever. The control group of facilities received rapid diagnostic tests and basic training in how to use them. A second arm provided healthworkers with training at the workplace, messages from senior staff and monthy supervision sessions. A third arm provided both healthworkers and community members with the same package as well as a community-based intervention to modify the expectations of patients. Data is collected through exit surveys of patients.

Health Systems
Impact of Interventions

Oct 2008 — Sep 2012

$1.66M

Tanzania