Minimising human error in malaria rapid diagnosis: clarity of written instructions and health worker performance

Waverly Rennie, Rattanaxay Phetsouvanh, Socorro Lupisan, Viengsay Vanisaveth, Bouasy Hongvanthong, Samlane Phompida, Portia Alday, Mila Fulache, Richard Lumagui, Pernille Jorgensen, David Bell, Steven Harvey

Research output: Contribution to journalArticlepeer-review


The usefulness of rapid diagnostic tests (RDT) in malaria case management depends on the accuracy of the diagnoses they provide. Despite their apparent simplicity, previous studies indicate that RDT accuracy is highly user-dependent. As malaria RDTs will frequently be used in remote areas with little supervision or support, minimising mistakes is crucial. This paper describes the development of new instructions (job aids) to improve health worker performance, based on observations of common errors made by remote health workers and villagers in preparing and interpreting RDTs, in the Philippines and Laos. Initial preparation using the instructions provided by the manufacturer was poor, but improved significantly with the job aids (e.g. correct use both of the dipstick and cassette increased in the Philippines by 17%). However, mistakes in preparation remained commonplace, especially for dipstick RDTs, as did mistakes in interpretation of results. A short orientation on correct use and interpretation further improved accuracy, from 70% to 80%. The results indicate that apparently simple diagnostic tests can be poorly performed and interpreted, but provision of clear, simple instructions can reduce these errors. Preparation of appropriate instructions and training as well as monitoring of user behaviour are an essential part of rapid test implementation.

Original languageEnglish (US)
Pages (from-to)9-18
Number of pages10
JournalTransactions of the Royal Society of Tropical Medicine and Hygiene
Issue number1
StatePublished - Jan 2007
Externally publishedYes


  • Community health workers
  • Diagnosis
  • Job aid
  • Malaria
  • Rapid diagnostic tests
  • User performance

ASJC Scopus subject areas

  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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