Abstract
BackgroundRapid diagnostic Tests (RDTs) for malaria enable diagnostic testing at primary care facilities in resource-limited settings, where weak infrastructure limits the use of microscopy. In 2010, Ghana adopted a test-before-treat guideline for malaria, with RDT use promoted to facilitate diagnosis. Yet healthcare practitioners still treat febrile patients without testing, or despite negative malaria test results. Few studies have explored RDT implementation beyond the notions of provider or patient acceptability. The aim of this study was to identify the factors directly influencing malaria RDT implementation at primary care facilities in a Ghanaian district.MethodsQualitative interviews, focus groups and direct observations were conducted with 50 providers at six purposively selected primary care facilities in the Atwima–Nwabiagya district. Data were analysed thematically.ResultsRDT implementation was hampered by: (1) healthcare delivery constraints (weak supply chain, limited quality assurance and control, inadequate guideline emphasis, staffing limitations); (2) provider perceptions (entrenched case-management paradigms, limited preparedness for change); (3) social dynamics of care delivery (expected norms of provider-patient interaction, test affordability); and (4) limited provider engagement in policy processes leading to fragmented implementation of health sector reform.ConclusionLimited health system capacity, socio-economic, political, and historical factors hampered malaria RDT implementation at primary care facilities in the study district. For effective RDT implementation providers must be: (1) adequately enabled through efficient allocation and management of essential healthcare commodities; (2) appropriately empowered with the requisite knowledge and skill through ongoing, effective professional development; and (3) actively engaged in policy dialogue to demystify socio-political misconceptions that hinder health sector reform policies from improving care delivery. Clear, consistent guideline emphasis, with complementary action to address deep-rooted provider concerns will build their confidence in, and promote uptake of recommended policies, practices, and technology for diagnosing malaria.
Highlights
Rapid diagnostic Tests (RDTs) for malaria enable diagnostic testing at primary care facilities in resourcelimited settings, where weak infrastructure limits the use of microscopy
This study reports descriptive findings from observations, qualitative interviews and focus groups discussions conducted with 50 primary care providers in the Atwima–Nwabiagya district to elicit their perspectives on RDT use and implementation at their facilities
Based on studies of RDT use in similar settings [24,25,26,27,28] and Ghana’s National Malaria Control Programme (NMCP) strategic plan [29], guideline compliance in this study was defined as a two-part commitment from the healthcare provider: (1) to test a patient suspected of having malaria using a RDT; and (2) to subsequently manage the case in a manner consistent with the test result
Summary
Rapid diagnostic Tests (RDTs) for malaria enable diagnostic testing at primary care facilities in resourcelimited settings, where weak infrastructure limits the use of microscopy. Febrile illnesses in settings including Ghana have been treated presumptively as malaria. This practice enabled prompt delivery of life-saving treatment to reduce mortality especially among children under 5 years of age [8]. Indiscriminate anti-malarial use, including incomplete dosing for repeated malarial infections, is prevalent in high transmission areas [9, 11] This fosters the emergence and spread of drug resistance [12], exacerbates a vicious cycle of illness and household poverty, and drains limited national and donor resources [13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
