Table 2.

Potential strategies to curb overtreatment of fever as malaria

Problem	Established approaches	Experimental approaches
Scenario 1: test not done, fever treated presumptively
RDT shortages	-	Using technology such as short text messaging (SMS), internet, and electronic mapping to track stock of RDTs 20 21
Limited RDT availability in private drug retail sector	-	Provision of free or subsidised RDTs through the private sector22 23
Staff shortages and high patient load in health centres	Use of community health workers to diagnose and treat uncomplicated malaria24 25	-
Scenario 2: test positive but the result is a false positive
Low specificity of tests	Regular quality testing of RDTs from manufacturers by WHO26	Enabling external QA of reading and interpretation of RDTs by sending test photographs via SMS11
		Urine or fluorescent RDTs27
Scenario 3: test negative; but antimalarial drugs are still prescribed
Uncertainty about RDT accuracy and perceived risk of mortality in people with false negatives results	Interactive educational meetings28 Multifaceted interventions including health workers, patients and the public 28 29 30	Evidence based training on the accuracy of RDTs and safety of not treating when results are negative31 32
	Accessible formats for guidelines, e.g. summaries33	Electronic or mobile friendly guidelines34
Uncertainty about how to manage fever when test is negative	Integrated case management of malarial and non-malarial causes of fever24 25	Improving referral paths for patients with negative results35
Expectation that patients will seek treatment elsewhere	Mass media interventions38	Incorporating patient communication skills in training packages of health workers32 36
		Use of clinic posters, decision aids and patient pamphlets and community awareness programmes32 36
		SMS reminders reiterating the treatment advice based on RDT result37