Introduction
malaria, fever
MALARIA, SECONDARY
Despite decades of control efforts, malaria remains a major public health problem. In 2019, an estimated 229 million cases of malaria occurred worldwide, most of which were in the WHO African Region (215 million or 94%).Prompt malaria diagnosis either by microscopy or rapid diagnostic tests (mRDTs) is recommended by WHO for all patients with suspected malaria before they are given treatment.The Kenya National Control Program adopted the Test and Treat policy in 2010 and this has been cascaded to the community level. The mRDTs are recommended for parasitological diagnosis in public health facilities where microscopy is not available and through community health workers (CHWs) in some regions. Despite these efforts, most people in rural Kenya still opt for self-treatment and seek care in the retail health sector.The deployment of mRDTs through trained CHWs could improve access to diagnostic testing for populations with limited access to health facilities. In a large, cluster randomised trial,Ideally, there should be adequate demand for the commodity or opportunity, and supply should be able to meet demand. In our cluster randomised trial, despite improvements in malaria testing before treatment of fever, we still observed that only 55% of those with recent illness reported having a malaria test before taking drugs and 21% still purchased antimalarials over the counter without a test,Here we report a secondary analysis of trial data collected at 12 and 18 months after the initiation of our cluster randomised trial of community-based diagnostic testing in western Kenya.