Abstract
Introduction: In sub-Saharan Africa, 80% to 85% of RDT negative febrile patients, seen in outpatient clinics, were given anti-malarial medicines. Previous studies recommended investigating determinants of “compliance with RDT’ results” in specific cadre and setting, as intervention is most effective when context specific. Compliance with malaria RDT results and correlates among clinicians in Uyo was determined. Methods: A cross-sectional study of clinicians selected using stratified sampling. Data were collected using self-administered, semi-structured questionnaire on socio-demographics, facility audit of RDT supplies, knowledge, perception and practice of clinicians. Outcome variable of interest was whether or not clinicians self-reported compliance with RDT results. Exposure variables of interest were whether or not clinicians received RDT training; received supportive supervision for malaria RDT; had positive perception of RDT usefulness; had good knowledge of RDT use (scores of ≥75% in questions testing for knowledge); had readily available treatment guidelines; had diagnostic capacity for other common febrile illness; experienced patient overload; experienced stock-out of supplies; work in the private/public sector. Descriptive, bivariate and multivariate analyses were conducted. Results: Mean age of the clinicians was 33.0 years ± (6.0 SD). Of the total clinicians, 31.1% were female; 66.0% received RDT training; 36.4% had supportive supervision; 43.3% exhibited good knowledge of RDT use; 45.3% had positive perception of RDT usefulness and 41.7% relied on presumptive diagnosis. Compliances with RDT negative and positive results were 66.4% and 83.4% respectively. Compliance with RDT negative result was more in clinicians with good knowledge of RDT use (aOR = 25.0; 95% CI = 2.92 - 213.52). Compliance with RDT positive result was more in clinicians with good knowledge of RDT use (aOR = 10.0; 95% CI =2.70 - 18.72), positive perception of RDT usefulness (aOR = 10.2; 95%CI =3.50 - 29.63) and in health facilities in the public sector (aOR = 5.0; 95% CI = 2.00- 11.11). Training on RDT use was not significantly associated with compliance with RDT negative (aOR = 1.25; 95% CI = 0.63 - 2.44) nor positive result (aOR = 2.0; 95% CI = 0.63 - 5.00). Conclusions: Compliance was higher with RDT positive result; more in the public sector; and in clinicians with good knowledge of RDT use. Efforts to improve compliance should focus on RDT negative results; clinicians with poor knowledge of RDT use and negative perception of RDT usefulness; and those in the private sector. However further research involving explicit (analytic) study of compliance with RDT results is recommended.
Highlights
In sub-Saharan Africa, 80% to 85% of Rapid Diagnostic Test (RDT) negative febrile patients, seen in outpatient clinics, were given anti-malarial medicines
Compliance was generally higher in the public sector
After controlling for confounding, compliance with RDT negative result was driven by knowledge of RDT use
Summary
Clinicians’ compliance with treatment guidelines is one of the components of effective case management of malaria. Microscopy for confirmation of malaria is expensive, time-consuming and labor-intensive These shortcomings partly informed the development of rapid diagnostic test [4]. Use of Rapid Diagnostic Test (RDT) for confirmation of malaria is suitable for resource-limited settings. It is more suitable in peripheral areas where microscopy is not available [5]. For the purpose of this study “compliance” refers to “self-reported compliance” (i.e. clinicians reported treating patients according to malaria RDT result consistently, in the two weeks prior to survey). Two weeks were adopted based on the study conducted by Pulford et al [6] He assumed that clinician self-report is a reliable proxy indicator of compliance, more accurate than patient self-report [7].
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