Evidence-based healthcare involves decision making about treatment and follow-up of the individual patient based on current and best clinical and diagnostic evidence. The use of evidence-based treatment has multiple impacts, including improving patient outcome, reducing the risk of development of drug resistance, and optimizing the use of valuable medical resources.
While its impact on poverty-related diseases could be enormous, a lack of adequate diagnostics is hampering evidence-based treatment for many poverty-related diseases in may low-resource settings, with far-reaching consequences.
In 2010 the WHO changed the guidance for malaria, to include point-of-care diagnostic testing (1), in response to the recognition that malaria was seriously over-diagnosed on the basis of only clinical symptoms, resulting in widespread unnecessary use of anti-malarial drugs which in turn exacerbated the development of drug-resistance. Despite this recognition and the improving diagnosis of malaria through the use of rapid malaria diagnostic tests the problem has still not been resolved. An important factor herein is the lack of adequate point-of-care diagnostic tests for the wide range of non-malaria febrile diseases for use in those patients who tested negative for malaria. These patients often remain undiagnosed or receive inadequate treatment resulting in poor outcomes.
For example: in a study in Tanzania (2) in 870 patients with febrile disease, malaria was diagnosed based on clinical symptoms alone in 61% of the cases. Proper diagnostic testing confirmed malaria in only 1.6%. Bloodstream ((myco-)bacterial and fungal) infections, acute bacterial zoonosis, and acute arbovirus infections were shown to be the true case of febrile disease in the non-malaria patients.
Evidence-based healthcare is not possible without access to proper diagnostic tools, leading to misdiagnosis and improper treatment, or no treatment at all. This in turn has serious impacts on the patient and his environment (extended illness and increased risk of other diseases, with long-term or even life-threatening consequences; cost of inappropriate and ineffective treatment; loss of income and/or education), and for the healthcare system (transmission to others; development of drug resistance; unnecessary and irrational use of medicines; increased use of more expensive laboratory testing; etc.).
Although the positive impact of affordable and reliable point-of-care diagnostics on the population, on the healthcare system, and on economic development is obvious, the problem of a lack of availability and access to adequate diagnostic tests persists.
Mondial Diagnostics strives to contribute to addressing this gap in availability of efficient diagnostic tools through the development of new rapid diagnostic tests that are reliable and affordable.
(1) Guidelines for the treatment of malaria. WHO, Geneva, 2010
(2) Crump et al: Etiology of severe non-malaria febrile illness in northern Tanzania - a prospective cohort study. Plos NTD 7(7): e2324 (2013)