BACKGROUND Malaria rapid diagnostic tests (RDT) are widely used in endemic areas in order to comply with the recommendation that malaria treatment should only be given after the clinical diagnosis has been confirmed by RDT or microscopy. However, the overestimation of malaria infection with the use of PfHRP2 based RDT, makes the management of febrile illnesses more challenging. This study aimed to assess the effect of the use of malaria RDT on antimicrobial prescription practices. METHODS A prospective study was conducted among febrile children under-5 years of age attending four health facilities and the referral hospital in the Nanoro Health District (Burkina Faso). To assess the effect of malaria RDT testing on the prescriptions of antimicrobials in febrile children, the initial diagnosis and antimicrobial prescriptions following a malaria RDT testing were recorded. The necessity of these prescriptions was subsequently checked by assessing the actual cause of fever by expert malaria microscopy and a microbiology analysis of blood, urine, stool and nasopharynx swabs that were collected from febrile cases to determine the actual cause of the fever episode. RESULTS Malaria was diagnosed by nurses, who are the primary health care providers, with a malaria RDT in 72.7% (798/1098) of febrile children, but only 53.7% (589/1097) cases could be confirmed by expert microscopy. Health care workers were likely to prescribe antimalarials to malaria positive RDT compared to malaria negative RDT (RR = 7.74, p = 0.00001). Malaria negative RDT result had a significant influence on the antibiotic prescriptions (RR = 3.57, p = 0.0001). The risk of prescribing antimicrobials was higher in health facility level compared to referral hospital. By cross-checking of laboratory findings to antimicrobial prescriptions, an important part of children with positive bacterial infection have received antibiotic prescriptions although the majority without any infection have also received antibiotics. CONCLUSION Despite the good attitude of health care workers to adhere to diagnostic test results, antimalarials and antibiotics remain inappropriate prescribed to febrile children. The low specificity of malaria RDT used could be an important cause of these practices.

中文翻译：

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疟疾快速诊断检测结果对布基纳法索医护人员抗菌药物处方实践的影响。

背景疟疾快速诊断检测（RDT）在流行地区被广泛使用，以符合只有在通过RDT或显微镜确认临床诊断后才进行疟疾治疗的建议。然而，使用基于 PfHRP2 的 RDT 对疟疾感染的高估使得发热性疾病的治疗更具挑战性。本研究旨在评估使用疟疾 RDT 对抗菌药物处方实践的影响。方法 对纳纳罗卫生区（布基纳法索）四个卫生机构和转诊医院的 5 岁以下发热儿童进行了一项前瞻性研究。为了评估疟疾 RDT 检测对发热儿童抗菌药物处方的影响，记录了疟疾 RDT 检测后的初步诊断和抗菌药物处方。随后，通过专家疟疾显微镜评估发烧的实际原因，并对从发热病例中收集的血液、尿液、粪便和鼻咽拭子进行微生物学分析，以确定发烧发作的实际原因，从而检查了这些处方的必要性。结果 疟疾由作为初级卫生保健提供者的护士诊断，72.7%（798/1098）的发热儿童接受了疟疾 RDT，但只有 53.7%（589/1097）的病例可以通过专家显微镜确诊。与疟疾阴性 RDT 相比，卫生保健工作者更有可能为疟疾阳性 RDT 开抗疟药（RR = 7.74，p = 0.00001）。疟疾阴性 RDT 结果对抗生素处方有显着影响（RR = 3.57，p = 0.0001）。与转诊医院相比，医疗机构开抗菌药物的风险更高。通过将实验室检查结果与抗菌药物处方进行交叉核对，发现细菌感染阳性的儿童中很大一部分已经接受了抗生素处方，尽管大多数没有任何感染的儿童也接受了抗生素治疗。结论 尽管卫生保健工作者态度良好，坚持遵守诊断检测结果，但抗疟药和抗生素仍然不适合给发热儿童开处方。所使用的疟疾 RDT 特异性低可能是造成这些做法的一个重要原因。