Malaria diagnosis and treatment practices following introduction of rapid diagnostic tests in Kibaha District, Coast Region, Tanzania

Abstract

BackgroundThe success of the universal parasite-based malaria testing policy for fever patients attending primary health care (PHC) facilities in Tanzania will depend highly on health workers’ perceptions and practices. The aim of this study was, therefore, to assess the present use of malaria diagnostics (rapid diagnostic tests (RDTs) and microscopy), prescription behaviour and factors affecting adherence to test results at PHC facilities in Kibaha District, Coast Region, Tanzania.MethodsExit interviews were conducted with fever patients at PHC facilities and information on diagnostic test performed and treatment prescribed were recorded. Interviews with prescribers to assess their understanding, perceptions and practices related to RDTs were conducted, and health facility inventory performed to assess availability of staff, diagnostics and anti-malarial drugs.ResultsThe survey was undertaken at ten governmental PHC facilities, eight of which had functional diagnostics. Twenty health workers were interviewed and 195 exit interviews were conducted with patients at the PHC facilities. Of the 168 patients seen at facilities with available diagnostics, 105 (63%) were tested for malaria, 31 (30%) of whom tested positive. Anti-malarial drugs were prescribed to all patients with positive test results, 14% of patients with negative results and 28% of patients not tested for malaria. Antibiotics were more likely to be prescribed to patients with negative test results compared to patients with positive results (81 vs 39%, p < 0.01) and among non-tested compared to those tested for malaria (84 vs 69%, p = 0.01). Stock-outs of RDTs and staff shortage accounted for the low testing rate, and health worker perceptions were the main reason for non-adherence to test results.ConclusionsAnti-malarial prescription to patients with negative test results and those not tested is still practiced in Tanzania despite the universal malaria testing policy of fever patients. The use of malaria diagnostics was also associated with higher prescription of antibiotics among patients with negative results. Strategies to address health system factors and health worker perceptions associated with these practices are needed.

Major Improvements in the Quality of Malaria Case-Management under the “Test and Treat” Policy in Kenya

“…First, testing rates increased by 34% reaching 58% of tested febrile patients at all facilities and 63% tested at facilities with available diagnostics. The testing levels were higher compared to reports from Zambia [18] and Angola [47], similar to those from several Tanzanian studies [9], [48]–[50] but lower compared to what can be achieved under more controlled, smaller scale conditions in Uganda [51]. Notably, at facilities providing both diagnostic services we found significantly higher testing rates (76%), preference for malaria microscopy, and in contrast with our previous findings [40], there was no difference in testing rates between facilities providing solely RDTs (55%) or malaria microscopy (58%).…”

Management and Follow-up Practices of Children with Unclassified Fever in Rural Ethiopia: Experiences of Health Extension Workers and Caregivers

“…19,20 In addition, although since 2010 the recommendation has been that antimalarial medication should only be given when a case is confirmed positive, 21 health workers still experience mistrust in mRDTs and insecurities about managing febrile children with negative mRDT results, thus often resorting to the use of antimalarials even when unnecessary. [22][23][24][25] It has been described that showing the test result to patients can help increase patients' trust and that a lack of communication about the test can lead to a patient misinterpreting its result. 20 Thus, particularly for negative malaria test results and low fever, where according to iCCM no medication should be given, clear communication to caregivers of sick children becomes important.…”

Simulations Show Diagnostic Testing For Malaria In Young African Children Can Be Cost-Saving Or Cost-Effective

“…Evidence shows that provider education and training can change practice patterns. 29 One way to promote use and compliance is to provide financial rewards linked to testing. Tying drug subsidies to testing is also worthy of consideration.…”