Universal access to malaria diagnostic testing; an operational manual
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Universal access to malaria diagnostic testing; an operational manual

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  • Description:
    The aim of this interagency manual is to provide policy, strategy, technical and operational guidance to countries wishing to strengthen or set up routine malaria diagnostic services. These services include the use of both microscopy and rapid diagnostic tests (RDTs) at all levels for the management of febrile patients by health workers and are integrated within other national programmes for strengthening laboratory services. This operational guide is primarily for national, provincial and district health and laboratory managers in ministries of health and malaria control programme and for the managers of other health agencies, nongovernmental organizations and faith-based organizations working with national health authorities to strengthen malaria diagnostic services. The manual starts with a section on programme aspects (section 1), followed by descriptions of the policies and guidelines that are needed in a programme to strengthen malaria diagnostic testing (section 2). The various activities are then described (sections 3-7), with the different aspects of monitoring and surveillance (sections 8 and 9). Strategies for particular settings are briefly proposed in section 10. Although the general approach is directed to programme management, some sections and tools might be useful for designing training materials and standard operating procedures for health professionals (doctors, nurses and health officers) and laboratory staff (scientists, technicians and microscopists) working in programmes for the diagnosis and treatment of patients with malaria. Most of the tools are described in the annexes to this manual. This manual is a synthesis of important issues published previously, presented in an accessible format, and is intended to give a practical approach to establishing a reliable system for malaria diagnostic testing. References to WHO publications available online, which provide more detailed information, are listed throughout this manual and in the annexes. The manual is intended to provide general guidance, which may help countries to prepare or revise their operational manuals by involving national health authorities and technical partners active in this area of work. For example, the manual makes reference to health facility support to community health workers in conducting malaria diagnostic testing at community level. These sections might not be relevant to all countries. The aim of the manual is to stimulate the development of malaria diagnostic testing and management, not as a vertical programme but integrated with activities at various levels of the health system. A key condition for its success is that malaria diagnostic testing not be practised on its own but as one component of the management of febrile patients, including causes of fever other than malaria. Experience in several countries (Burkina Faso, Ghana, Nigeria, Papua New Guinea, Uganda, the United Republic of Tanzania (including Zanzibar) and Zambia) has shown that, with good training and support, health workers adhere to the results of malaria tests and treat only positive patients. This manual provides technical guidance on who should be tested for malaria and how. This is a major shift from other criteria for deciding who should be treated for malaria. It aligns the management of malaria with that of any other disease for which a reliable diagnostic test is universal access to malaria diagnostic testing: An operational manual available. When the terms 'RDT' and 'microscopy' are used in a recommendation, it is considered as implicit that the tests are quality assured and therefore that they provide reliable, reproducible results in line with their technical characteristics. When not explicitly mentioned, the statements in the manual apply to all Plasmodium species (falciparum and non-falciparum). This manual is intended to be read comprehensively, although some sections and tools given in the annexes can stand alone.
  • Content Notes:
    The manual has been developed from a draft framework document jointly prepared by the WHO Global Malaria Programme (WHO/GMP) and the US Centers for Disease Control and Prevention (CDC) in 2009, named "Malaria Diagnosis: An Operational Guideline for Strengthening Malaria Diagnostic Services". This document was shared in March 2010 with the members of the diagnostic work-stream of the Roll Back Malaria Case Management Working Group, to serve as a basis for further development into a new inter-agency manual on universal access to diagnostic testing of malaria.
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