***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To examine the extent to which district health teams could reduce the burden of malaria , a continuing major cause of mortality and morbidity , in a situation where severe re source constraints existed and integrated care was provided . METHODS Antimalarial drugs were prepackaged into unit doses in an attempt to improve compliance with full courses of chemotherapy . FINDINGS Compliance improved by approximately 20 % in both adults and children . There were 50 % reductions in cost to patients , waiting time at dispensaries and drug wastage at facilities . The intervention , which tended to improve both case and drug management at facilities , was well accepted by health staff and did not involve them in additional working time . CONCLUSION The prepackaging of antimalarials at the district level offers the prospect of improved compliance and a reduction in the spread of resistance Abstract Objective To compare the impact of malaria rapid diagnostic tests ( mRDTs ) , used by community health workers ( CHWs ) , on the proportion of children < 5 years of age receiving appropriately targeted treatment with artemisinin‐based combination therapy ( ACT ) , vs.  presumptive treatment . Methods Cluster‐r and omized trials were conducted in two contrasting areas of moderate‐to‐high and low malaria transmission in rural Ug and a. Each trial examined the effectiveness of mRDTs  in the management of malaria and targeting of  ACTs  by CHWs comparing two diagnostic approaches : ( i ) presumptive clinical diagnosis of malaria [ control arm ] and ( ii ) confirmatory diagnosis with mRDTs followed by ACT treatment for positive patients [ intervention arm ] , with village as the unit of r and omisation . Treatment decisions by CHWs were vali date d by microscopy on a reference blood slide collected at the time of consultation , to compare the proportion of children < 5 years receiving appropriately targeted ACT treatment  , defined as patients with microscopically‐confirmed presence of parasites in a peripheral blood smear receiving  artemether‐lumefantrine or rectal artesunate , and patients with no malaria parasites not given ACT . Results In the moderate‐to‐high transmission area , ACT treatment was appropriately targeted in 79.3 % ( 520/656 ) of children seen by CHWs using mRDTs to diagnose malaria , vs. 30.8 % ( 215/699 ) of children seen by CHWs using presumptive diagnosis ( P < 0.001 ) . In the low transmission area , 90.1 % ( 363/403 ) children seen by CHWs using mRDTs received appropriately targeted ACT treatment vs. 7.8 % ( 64/817 ) seen by CHWs using presumptive diagnosis ( P < 0.001 ) . Low mRDT sensitivity in children with low‐density parasitaemia ( < 200 parasites/μl ) was identified as a potential concern . Conclusion When equipped with mRDTs , ACT  treatments delivered by CHWs are more accurately targeted to children with malaria parasites . mRDT use could play an important role in reducing overdiagnosis of malaria and improving fever case management within iCCM , in both moderate‐to‐high and low transmission areas . Nonetheless , missed treatments due to the low sensitivity of current mRDTs in patients with low parasite density are a concern . For community‐based treatment in areas of low transmission and /or non‐immune population s , presumptive treatment of all fevers as malaria may be advisable , until more sensitive diagnostic assays , suitable for routine use by CHWs in remote setting s , become available Background It is important that community-based health insurance ( CBHI ) schemes are design ed in such a way as to ensure the relevance of the benefit packages to potential clients . Hence , this paper provides an underst and ing of the preferred benefit packages by different economic status groups as well as urban and rural dwellers for CBHI in Southeast Nigeria . Methods The study took place in rural , urban and semi-urban communities of south-east Nigeria . A question naire was used to collect information from 3070 r and omly picked household heads . Focus group discussion s were used to collect qualitative data . Data was examined for links between preferences for benefit packages with SES and geographic residence of the respondents . Results Respondents in the rural areas and in the lower SES preferred a comprehensive benefit package which includes all inpatient , outpatient and emergencies services , while those in urban areas as well as those in the higher SES group showed a preference for benefit packages which will cover only basic disease control interventions . Conclusion Equity concerns in preferences for services to be offered by the CBHI scheme should be addressed for CBHI to succeed in different context Background The increasing investment in malaria rapid diagnostic tests ( RDTs ) to differentiate malarial and non-malarial fevers , and an awareness of the need to improve case management of non-malarial fever , indicates an urgent need for high quality evidence on how best to improve prescribers ’ practice s. Methods A three-arm stratified cluster-r and omised trial was conducted in 36 primary healthcare facilities from September 2010 to March 2012 within two rural districts in northeast Tanzania where malaria transmission has been declining . Interventions were guided by formative mixed- methods research and were introduced in phases . Prescribing staff from all facilities received st and ard Ministry of Health RDT training . Prescribers from facilities in the health worker ( HW ) and health worker-patient ( HWP ) arms further participated in small interactive peer-group training sessions with the HWP additionally receiving clinic posters and patient leaflets . Performance feedback and motivational mobile-phone text messaging ( SMS ) were added to the HW and HWP arms in later phases . The primary outcome was the proportion of patients with a non-severe , non-malarial illness incorrectly prescribed a ( recommended ) antimalarial . Secondary outcomes investigated RDT uptake , adherence to results , and antibiotic prescribing . Results St and ard RDT training reduced pre-trial levels of antimalarial prescribing , which was sustained throughout the trial . Both interventions significantly lowered incorrect prescribing of recommended antimalarials from 8 % ( 749/8,942 ) in the st and ard training arm to 2 % ( 250/10,118 ) in the HW arm ( adjusted RD ( aRD ) 4 % ; 95 % confidence interval ( CI ) 1 % to 6 % ; P = 0.008 ) and 2 % ( 184/10,163 ) in the HWP arm ( aRD 4 % ; 95 % CI 1 % to 6 % ; P = 0.005 ) . Small group training and SMS were incrementally effective . There was also a significant reduction in the prescribing of antimalarials to RDT-negatives but no effect on RDT-positives receiving an ACT . Antibiotic prescribing was significantly lower in the HWP arm but had increased in all arms compared with pre-trial levels . Conclusions Small group training with SMS was associated with an incremental and sustained improvement in prescriber adherence to RDT results and reducing over-prescribing of antimalarials to close to zero . These interventions may become increasingly important to cope with the wider range of diagnostic and treatment options for patients with acute febrile illness in Africa . Trial registration Clinical Trials.gov ( # NCT01292707 ) 29 January 2011 Background Malaria is a major cause of paediatric morbidity and mortality . As no clinical features clearly differentiate malaria from other febrile illnesses , and malaria diagnosis is challenged by often lacking laboratory equipment and expertise , overdiagnosis and overtreatment is common . Methods Children admitted with fever at the general paediatric wards at Muhimbili National Hospital ( MNH ) , Dar es Salaam , Tanzania from January to June 2009 were recruited consecutively and prospect ively . Demographic and clinical features were registered . Routine thick blood smear microscopy at MNH was compared to results of subsequent thin blood smear microscopy , and rapid diagnostics tests ( RDTs ) . Genus-specific PCR of Plasmodium mitochondrial DNA was performed on DNA extracted from whole blood and species-specific PCR was done on positive sample s. Results Among 304 included children , 62.6 % had received anti-malarials during the last four weeks prior to admission and 65.1 % during the hospital stay .  Routine thick blood smears , research blood smears , PCR and RDT detected malaria in 13.2 % , 6.6 % , 25.0 % and 13.5 % , respectively . Positive routine microscopy  was confirmed in only 43 % ( 17/40 ) , 45 % ( 18/40 ) and 53 % ( 21/40 ) , by research microscopy , RDTs and PCR , respectively . Eighteen percent ( 56/304 ) had positive PCR but negative research  microscopy  . Reported low parasitaemia on routine microscopy was associated with negative research blood slide and PCR . RDT-positive cases were associated with signs of severe malaria . Palmar pallor , low haemoglobin and low platelet count were significantly associated with positive PCR , research microscopy and RDT . Conclusions The true morbidity attributable to malaria in the study population remains uncertain due to the discrepancies in results among the diagnostic methods . The current routine microscopy appears to result in overdiagnosis of malaria and , consequently , overuse of anti-malarials . Conversely , children with a false positive malaria diagnosis may die because they do not receive treatment for the true cause of their illness . RDTs appear to have the potential to improve routine diagnostics , but the clinical implication of the many RDT-negative , PCR-positive sample s needs to be eluci date Background Artemisinin-based combination therapy ( ACT ) is the first-line malaria treatment throughout most of the malaria-endemic world . Data on ACT availability , price and market share are needed to provide a firm evidence base from which to assess the current situation concerning quality -assured ACT supply . This paper presents supply side data from ACTwatch outlet surveys in Benin , the Democratic Republic of Congo ( DRC ) , Madagascar , Nigeria , Ug and a and Zambia . Methods Between March 2009 and June 2010 , nationally representative surveys of outlets providing anti-malarials to consumers were conducted . A census of all outlets with the potential to provide anti-malarials was conducted in clusters sample d r and omly . Results 28,263 outlets were censused , 51,158 anti-malarials were audited , and 9,118 providers interviewed . The proportion of public health facilities with at least one first-line quality -assured ACT in stock ranged between 43 % and 85 % . Among private sector outlets stocking at least one anti-malarial , non-artemisinin therapies , such as chloroquine and sulphadoxine-pyrimethamine , were widely available ( > 95 % of outlets ) as compared to first-line quality -assured ACT ( < 25 % ) . In the public/not-for-profit sector , first-line quality -assured ACT was available for free in all countries except Benin and the DRC ( US$ 1.29 [ Inter Quartile Range ( IQR ) : $ 1.29-$1.29 ] and $ 0.52[IQR : $ 0.00-$1.29 ] per adult equivalent dose respectively ) . In the private sector , first-line quality -assured ACT was 5 - 24 times more expensive than non-artemisinin therapies . The exception was Madagascar where , due to national social marketing of subsidized ACT , the price of first-line quality -assured ACT  ( $ 0.14 [ IQR : $ 0.10 , $ 0.57 ] ) was significantly lower than the most popular treatment ( chloroquine , $ 0.36 [ IQR : $ 0.36 , $ 0.36 ] ) .  Quality -assured ACT accounted for less than 25 % of total anti-malarial volumes ; private-sector quality -assured ACT volumes represented less than 6 % of the total market share . Most anti-malarials were distributed through the private sector , but often comprised non-artemisinin therapies , and in the DRC and Nigeria , oral artemisinin monotherapies .  Provider knowledge of the first-line treatment was significantly lower in the private sector than in the public/not-for-profit sector . Conclusions These st and ardized , nationally representative results demonstrate the typically low availability , low market share and high prices of ACT , in the private sector where most anti-malarials are accessed , with some exceptions . The results confirm that there is substantial room to improve availability and affordability of ACT treatment in the surveyed countries . The data will also be useful for monitoring the impact of interventions such as the Affordable Medicines Facility for malaria Background Early diagnosis and prompt , effective treatment of uncomplicated malaria is critical to prevent severe disease , death and malaria transmission . We assessed the impact of rapid malaria diagnostic tests ( RDTs ) by community health workers ( CHWs ) on provision of artemisinin-based combination therapy ( ACT ) and health outcome in fever patients . Methodology /Principal Findings Twenty-two CHWs from five villages in Kibaha District , a high-malaria transmission area in Coast Region , Tanzania , were trained to manage uncomplicated malaria using RDT aided diagnosis or clinical diagnosis ( CD ) only . Each CHW was r and omly assigned to use either RDT or CD the first week and thereafter alternating weekly . Primary outcome was provision of ACT and main secondary outcomes were referral rates and health status by days 3 and 7 . The CHWs enrolled 2930 fever patients during five months of whom 1988 ( 67.8 % ) presented within 24 hours of fever onset . ACT was provided to 775 of 1457 ( 53.2 % ) patients 
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Overall ,  RDTs were performed safely and effectively by community health workers provided they receive proper training .
Analogous information was largely absent for formal health care workers .
Tests were generally accurate across context s , except for in drug shops where lower specificities were observed .
Conclusions Malaria RDTs are generally used well , though compliance with test results is variable – especially in the formal health care sector .