28–30 The availability find more of skilled microscopists to prepare and read slides accurately and reliably is an added challenge in low and middle-income countries.31, 32 A diagnostic tool that could be easily and rapidly applied to many patients within a short time was needed. Such a diagnostic

test needed to be one that both professional and non-professional health workers could perform. Presumptive management of malaria formed the basis of the treatment of malaria within the Integrated Management of Childhood Illnesses (IMCI) where all under-five children who presented with fever were prescribed an antimalarial.7 Arguments for and against the shift It is now argued that the presumptive approach is no longer justifiable and there is a need to shift to the test-based approach.33–35 However, the decision to shift from presumptive to test-based approach in managing malaria has occasioned considerable debate. 6, 36–38 Those who favoured the shift to test-based management of malaria argued that the factors that justified the presumptive approach were no longer valid. Malaria transmission, originally high, has been declining and affordable antimalarials were no longer effective

and had been replaced with the more expensive artemisinin-based combination therapy (ACT). They also argued that smear selleck chemical microscopy was no longer the only practical means of confirming the diagnosis of malaria at the point of care due to the availability of malaria rapid diagnostic tests (mRDTs). Those who favoured the shift further argued that test-based approach would lead to improvement in the management of non-malaria febrile illnesses. 33 Those who opposed the shift to test based management

argued that there was insufficient evidence that malaria was on a sustainable decline. They questioned the capacity of malaria-endemic country health systems to sustain stock of quality-assured RDTs. They further believed that there was insufficient evidence on the safety of restricting ACT to test-positive cases and that a policy of test-based management of malaria would not necessarily lead to improvement in the management of non-malarial febrile illnesses.38, 39 In evaluating the appropriateness because of implementing the shift to test-based management of malaria in Ghana, it is important to assess whether local and sub-regional evidence, supports the decline of malaria and whether the available RDTs are accurate and reliable. Is malaria on a sustainable decline? Recent reports suggest that the burden of malaria is declining in many areas of sub-Saharan Africa. 40, 41 According to the 2010 and 2011 World Malaria Reports, appreciable progress was made between 2000 and 2010 to reduce the burden of malaria globally. A 26% decline in malaria deaths was recorded globally, with sub-Saharan Africa accounting for 33% of this decline.