Abstract
In Papua New Guinea (PNG), a malaria treatment policy using rapid diagnostic tests (RDTs) plus artemisinin-based combination therapy (ACT) was widely introduced to rural communities in 2012. The objectives of the study were to evaluate the effect of this RDT/ACT introduction to a rural PNG population on health service utilization and to compare factors associated with health service utilization before and after the RDT/ACT introduction. Household surveys with structured questionnaires were conducted before and after the introduction of RDT/ACT in a catchment area of a health center in East Sepik Province, PNG. We interviewed caregivers with children less than 15 years of age and collected data on fever episodes in the preceding 2 weeks. Using propensity score matching, febrile children before the introduction of RDT/ACT were matched to febrile children after the introduction. Then, the adjusted difference in the proportion of health service utilization [i.e., the average treatment effect (ATE) of the introduction of RDT/ACT on health service utilization] was estimated. We also employed a multilevel Poisson regression model to investigate factors influencing the use of health services. Of 4,690 children, 911 (19%) were reported to have a fever episode. The unadjusted proportion of health service utilization was 51.7 and 57.2% before and after the RDT/ACT introduction, respectively. After matching, no significant difference in the health service utilization was observed before and after the introduction of RDT/ACT (ATE: 0.063, 95% confidence interval -0.024 to 0.150). Multilevel regression analysis showed that the consistent factors associated with a higher utilization of health services were severe illness and being female. The utilization of health services was not significantly different before and after the introduction of RDT/ACT. Villagers may have neither sufficient informations on the new protocol nor high acceptance of RDT/ACT. The observed gender bias in health service utilization could be due to female caregivers' preferences toward girls.
Highlights
Despite the recent progress of investments in global malaria control, an estimated 212 million malaria cases and 429,000 malaria deaths still occurred in 2015 worldwide [1]
We have shown that (a) the introduction of Rapid diagnosis test (RDT) and artemisinin-based combination therapy (ACT) did not significantly affect the utilization of health facilities offering such services and (b) illness severity and gender of patient were consistent determinants of health service utilization before and after the introduction of RDT/ACT
We showed no significant effect of RDT/ACT on health service utilization with adjustments for availability, accessibility, and affordability of health-care facilities as well as patient-related individual characteristics using propensity score matching
Summary
Despite the recent progress of investments in global malaria control, an estimated 212 million malaria cases and 429,000 malaria deaths still occurred in 2015 worldwide [1]. Parasite-based diagnosis is desirable before use of ACT because over-prescription of ACT, which is much more expensive than using conventional drugs, is a great threat to cost-effective intervention. Rapid diagnosis test (RDT) for malaria, enables accurate diagnosis in rural settings because it is easy to use, not time-consuming, and does not require electricity unlike microscopic examination [3]. In 2010, WHO changed the policy from clinical diagnosis to parasitological diagnosis, with either microscopy or RDT for all suspected malaria cases prior to treatment [4]. In Papua New Guinea (PNG), a malaria treatment policy using rapid diagnostic tests (RDTs) plus artemisinin-based combination therapy (ACT) was widely introduced to rural communities in 2012. The objectives of the study were to evaluate the effect of this RDT/ACT introduction to a rural PNG population on health service utilization and to compare factors associated with health service utilization before and after the RDT/ACT introduction
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