Management of fever among under-fives and utility of malaria rapid diagnostic test under reduced malaria burden in Rufiji District, Southeastern Tanzania

Objective: To investigate case management of fever among under-fives, performance and\udutility of malaria rapid diagnostic test (mRDT) under reduced malaria burden in Rufiji District,\udSoutheastern Tanzania.\udMethods: A quantitative cross sectional study was conducted at primary health facilities in\udRufiji District from April to May 2012. Information on socio-demographic characteristics,\udhistory and duration of fever, fever measurement, clinical diagnosis and drugs prescribed\udwere recorded. Parasitological malaria confirmation was done by mRDT and microscopy.\udPerformance of mRDT and utility of mRDT results to guide on the management of malarial and\udnon-malarial fevers were assessed.\udResults: Of the 466 under-fives with fever, 111 (23.8%) were mRDT positive and 100 (21.5%)\udwere microscopically positive for malaria. Sensitivity and specificity of mRDT were 90% [95%\udconfidence interval (CI): 82.6%–94.5%] and 94.3% (95% CI: 91.4%–96.2%) respectively;\udoverall diagnostic accuracy was 93.3% (95% CI: 91.1%–95.6%). A total of 130 (28.5%) underfives received an antimalarial. Among them, 109 (83.8%) were mRDT positive while 21 (16.2%)\udwere negative. Of the 100 under-fives with microscopic parasitaemia, 34 had counts > 200 000/\udµL an indication for quinine but only 5/34 (14.7%) received quinine prescription. Five underfives with parasitaemia > 200 000/µL had negative mRDT results. Being mRDT negative was\udsignificantly associated with receipt of an antibiotic prescription (χ2 = 162.2, P < 0.001).\udConclusions: Use of mRDT reduced unnecessary antimalarial use by 71.5%. However, this\udhad the potential for over prescribing an antibiotic for non-malarial fevers. The diagnostic\udperformance of mRDT was still high despite decline in malaria burden