Whilst 2010 recommending diagnostic confirmation prior to treatment

Whilst the AMFm programme has beensuccessful in improving access to ACTs across the country, they are frequentlyprescribed without parasitological confirmation of malaria8, 9, 13–15. This is despite the WHO Global Malaria Programme releasing revisedguidelines in 2010 recommending diagnostic confirmation prior to treatment ofall suspected malaria cases16, 17.

The improper use of ACTs not only results in inappropriatetreatment of fever but also increases the selective pressure for resistance inparasite populations and limits ACT availability for those that require them15, 18, 19. Given that up to 80% of fevers in Uganda are reportedly treated inthe informal and private sectors 1, there is a lack of access to diagnostic tools 20. Demonstrating this, a 2012 study showed that out of febrilechildren receiving treatment in the private sector, only 10.

3% were givenappropriate care 8. To ensure proper case management and reduce the overuse of ACTs, thereis an urgent requirement to provide the private sector with the tools to diagnosepotential malarial episodes. Rapid diagnostic tests (RDTs) are a quick, affordable and accurate way to ensure appropriate treatment, without the needfor special laboratory equipment or extensive training 14.  A study in central Uganda showed that theimplementation of subsidised RDTs was successful in decreasing the use of ACTs, with the proportion of febrile patients receiving appropriate treatmentincreasing from 33. 7% to 72.

9% 15. In addition to this, behavioural studies looking at theintroduction of RDTs into registered drug shops have shown that clients welcomedthe availability of diagnosis and the drug-vendors embraced the ability todemonstrate a new technical skill 11. RDTs, by encouraging the use of legal registered drug stores wouldalso assist in integrating them into the hierarchy of the formal health caresystem11, 21. Furthermore, the administration of ACTs only to confirmed malaria casesmay help to strengthen the public trust in the drugs and encourage their properuse 22.

It has been demonstrated that the introduction of RDTs into theprivate sector in Kampala is feasible and welcomed by the community11, 18, 23, 24. However it has also been shown that the RDTs must be highlysubsidised as the price that a consumer was willing-to-pay was lower thanend-user prices 25. It is clear that improved access to diagnostics in the privatesector will be hugely beneficial for those who have limited access to publichealth care facilities 26.