Health workers’ perception of malaria rapid diagnostic test and factors influencing compliance with test results in Ebonyi state, Nigeria

Abstract

BackgroundThe standard practice in treating uncomplicated malaria is to prescribe artemisinin-based combination therapy (ACT) for only patients with positive test results. However, health workers (HWs) sometimes prescribe ACTs for patients with negative malaria rapid diagnostic test (mRDT) results. Available evidence on HWs perception of mRDT and their level of compliance with test results in Nigeria lacks adequate stratification by state and context. We assessed HWs perception of mRDT and factors influencing ACTs prescription to patients with negative mRDT results in Ebonyi state, Nigeria.MethodsA cross-sectional survey was conducted among 303 HWs who treat suspected malaria patients in 40 randomly selected public and private health facilities in Ebonyi state. Health workers’ perception of mRDT was assessed with 18 equally weighted five-point likert scale questions with maximum obtainable total score of 90. Scores ≥72 were graded as good and less, as poor perception. Data were analysed using descriptive statistics and logistic regression model at 5% significance level.ResultsMean age of respondents was 34.6±9.4 years, 229 (75.6%) were females, 180 (59.4%) community health workers and 67 (22.1%) medical doctors. Overall, 114 (37.6%) respondents across healthcare facility strata had poor perception of mRDT. Respondents who prescribed ACTs to patients with negative mRDT results within six months preceding the survey were 154 (50.8%) [PHCs: 50 (42.4%), General hospitals: 18 (47.4%), tertiary facility: 51 (79.7%) and missionary hospitals: 35 (42.2%)]. Poor HWs’ perception of mRDT promoted prescription of ACT to patients with negative mRDT results (AOR = 5.6, 95% C.I = 3.2–9.9). The likelihood of prescribing ACTs to patients with negative mRDT results was higher among HWs in public health facilities (AOR = 2.8, 95% C.I = 1.4–5.5) than those in the private.ConclusionsThe poor perception of mRDT and especially common prescribing of ACTs to patients with negative mRDT results among HWs in Ebonyi state calls for context specific interventions to improve their perception and compliance with mRDT test results.

Malaria Diagnosis and Treatment: Perception of Community Pharmacists in Abuja Metropolis, Nigeria

“…There was no significant association of respondents' characteristics to their prescribing ACT for negative RDT test results. This contrast a study by Izuchukwu Frank Obi et al [17], which reported prescriber's professional cadre, perception of RDT, training on other causes of fever and health facility level to be significantly associated with ACT prescription to patients with negative RDT results. Prescription of ACTs to negative results may be due to lack of trust for a negative confirmatory result for malaria diagnosis as truly ruling out malaria, poor perception of confirmatory test to detect plasmodium parasite [17], to please patient or not to be seen as incompetent [19].…”

“…A holistic training on WHO (testing, treating and tracking) malaria case management will help community pharmacist better appreciate the importance of practicing the WHO T3. Similarly, in a study by Izuchukwu Frank Obi et al [17] amongst health workers in Ebonyi state revealed that respondents socio-demographic characteristics did not impact significantly on health workers practice of malaria diagnosis. However, in this study it was discovered that significantly higher proportion of those who had received Training in testing practiced all three components (Testing, Treatment, and Tracking) of the WHO T3 initiative on malaria case management.…”

“…This is in line with findings from previous study by Ndibuagu et al [13], where it was reported that 64% of healthcare providers thought it was important to perform a confirmatory diagnosis before commencing treatment, 70.9% opined that presumptive diagnosis of malaria is not a better way of making diagnosis and 76.7% did not believe malaria diagnosis is always clear on listening to the patient. In contrast Izuchukwu Frank Obi et al [17] noted poor perception of healthcare workers on mRDT that resulted in prescription of ACTs to negative cases though over 90% agreed that febrile patients should be tested before commencement of treatment. Most of the respondents stated that they have confidence in results from the malaria confirmatory test, this is supported study by Izuchukwu Frank Obi et al [17], showed that more than 80% of respondent said they fully trust a positive mRDT.…”

“…In contrast Izuchukwu Frank Obi et al [17] noted poor perception of healthcare workers on mRDT that resulted in prescription of ACTs to negative cases though over 90% agreed that febrile patients should be tested before commencement of treatment. Most of the respondents stated that they have confidence in results from the malaria confirmatory test, this is supported study by Izuchukwu Frank Obi et al [17], showed that more than 80% of respondent said they fully trust a positive mRDT. However, those that indicated that they trust their skills in performing malaria test were less than 70%.…”

When Knowledge Is Not Enough: Applying a Behavioral Design Approach to Improve Fever Case Management in Nigeria

“…Although the National Guidelines for Diagnosis and Treatment of Malaria 2015 4 emphasize the need for parasitological confirmation before prescribing antimalarial drugs, many health care providers (23%–51%) in the public sector prescribe ACTs to clients who test negative for malaria. 5 , 6 The 2018 Nigeria Demographic and Health Survey also found that of 7,466 children younger than 5 years with fever in the 2 weeks preceding the survey, only 1,030 had blood drawn for malaria testing, yet 3,244 children took antimalarials (and over half of those children took ACTs). 7 This suggests that testing and treating based on test results is not widespread.…”