Connected diagnostics to improve accurate diagnosis, treatment, and conditional payment of malaria services in Kenya.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read Online Read More Add to Saved list
  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101088682 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6947 (Electronic) Linking ISSN: 14726947 NLM ISO Abbreviation: BMC Med Inform Decis Mak Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, [2001-
    • Subject Terms:
      Antimalarials*/therapeutic use ; COVID-19* ; Malaria*/diagnosis ; Malaria*/drug therapy; Humans ; Kenya ; SARS-CoV-2
    • Abstract:
      Background: In sub-Saharan Africa, the material and human capacity to diagnose patients reporting with fever to healthcare providers is largely insufficient. Febrile patients are typically treated presumptively with antimalarials and/or antibiotics. Such over-prescription can lead to drug resistance and involves unnecessary costs to the health system. International funding for malaria is currently not sufficient to control malaria. Transition to domestic funding is challenged by UHC efforts and recent COVID-19 outbreak. Herewith we present a digital approach to improve efficiencies in diagnosis and treatment of malaria in endemic Kisumu, Kenya: Connected Diagnostics. The objective of this study is to evaluate the feasibility, user experience and clinical performance of this approach in Kisumu.
      Methods: Our intervention was performed Oct 2017-Dec 2018 across five private providers in Kisumu. Patients were enrolled on M-TIBA platform, diagnostic test results digitized, and only positive patients were digitally entitled to malaria treatment. Data on socio-demographics, healthcare transactions and medical outcomes were analysed using standard descriptive quantitative statistics. Provider perspectives were gathered by 19 semi-structured interviews.
      Results: In total 11,689 febrile patients were digitally tested through five private providers. Malaria positivity ranged from 7.4 to 30.2% between providers, significantly more amongst the poor (p < 0.05). Prescription of antimalarials was substantially aberrant from National Guidelines, with 28% over-prescription (4.6-63.3% per provider) and prescription of branded versus generic antimalarials differing amongst facilities and correlating with the socioeconomic status of clients. Challenges were encountered transitioning from microscopy to RDT.
      Conclusion: We provide full proof-of-concept of innovative Connected Diagnostics to use digitized malaria diagnostics to earmark digital entitlements for correct malaria treatment of patients. This approach has large cost-saving and quality improvement potential.
      (© 2021. The Author(s).)
    • References:
      PLoS One. 2019 Sep 26;14(9):e0222651. (PMID: 31557170)
      Malar J. 2015 Jul 08;14:263. (PMID: 26152272)
      Am J Clin Pathol. 2014 Jun;141(6):791-5. (PMID: 24838322)
      BMJ Glob Health. 2017 May 16;2(2):e000176. (PMID: 29242750)
      Malar J. 2016 Nov 14;15(1):555. (PMID: 27842555)
      Lancet. 2020 Apr 4;395(10230):1094-1096. (PMID: 32192582)
      Trop Med Int Health. 2015 Dec;20(12):1685-95. (PMID: 26338026)
      Expert Rev Pharmacoecon Outcomes Res. 2016 Oct;16(5):639-650. (PMID: 26567041)
      PLoS Med. 2009 Jan 6;6(1):e252. (PMID: 19127974)
      Malar J. 2018 Apr 16;17(1):166. (PMID: 29661245)
      Am J Trop Med Hyg. 2009 Mar;80(3):470-4. (PMID: 19270300)
      BMC Health Serv Res. 2012 Sep 03;12:297. (PMID: 22943592)
      Malar J. 2017 Dec 21;16(1):494. (PMID: 29268789)
      BMC Med Inform Decis Mak. 2019 Jul 22;19(1):139. (PMID: 31331394)
      Annu Int Conf IEEE Eng Med Biol Soc. 2009;2009:1730-3. (PMID: 19964260)
      Malar J. 2016 Mar 22;15:179. (PMID: 27006074)
      PLoS One. 2013;8(2):e54305. (PMID: 23418427)
      N Engl J Med. 2014 Feb 27;370(9):809-17. (PMID: 24571753)
      Malar J. 2008 Feb 18;7:33. (PMID: 18282270)
      Trop Med Int Health. 2001 Feb;6(2):99-101. (PMID: 11251904)
    • Contributed Indexing:
      Keywords: Conditional payments; Connected diagnostics; Diagnosis; Kenya; Malaria; Treatment
    • Accession Number:
      0 (Antimalarials)
    • Publication Date:
      Date Created: 20210805 Date Completed: 20210809 Latest Revision: 20210809
    • Publication Date:
      20240105
    • Accession Number:
      PMC8335459
    • Accession Number:
      10.1186/s12911-021-01600-z
    • Accession Number:
      34348696