Abstract
BackgroundIn Uganda, as in most other malaria-endemic countries, presumptive treatment for malaria based on symptoms without a diagnostic blood test is still very common. While diagnostic testing in public sector facilities is increasing, many people in Uganda who suspect malaria visit private sector outlets to purchase medications. Increasing the availability and uptake of rapid diagnostic tests (RDTs) for malaria in private outlets could help increase diagnostic testing for malaria but raises questions about the patient demand for and valuation of testing that are less critical for public sector introduction.MethodsIn preparation for a behaviour change campaign to encourage and sustain the demand for RDTs in drug shops, eight focus group discussions with a total of 84 community members were conducted in six districts across Uganda’s Eastern Region in November-December 2011. Focus groups explored incentives and barriers to seeking diagnosis for malaria, how people react to test results and why, and what can be done to increase the willingness to pay for RDTs.ResultsOverall, participants were very familiar with malaria diagnostic testing and understood its importance, yet when faced with limited financial resources, patients preferred to spend their money on medication and sought testing only when presumptive treatment proved ineffective. While side effects did seem to be a concern, participants did not mention other potential costs of taking unnecessary or ineffective medications, such as money wasted on excess drugs or delays in resolution of symptoms. Very few individuals were familiar with RDTs.ConclusionIn order to boost demand, these results suggest that private sector RDTs will have to be made convenient and affordable and that targeted behaviour change campaigns should strive to increase the perceived value of diagnosis.
Highlights
In Uganda, as in most other malaria-endemic countries, presumptive treatment for malaria based on symptoms without a diagnostic blood test is still very common
Study design and questionnaire The primary objective of this study was to explore the following research question: What are the barriers and incentives to purchasing malaria diagnosis among patients and what recommendations can be made for boosting demand for rapid diagnostic tests (RDTs) introduced into the private sector, in drug shops? Focus group discussions were conducted with community members to explore both community practices and perceptions around malaria diagnosis
The results of this study shed light on the five potential barriers to patient demand and willingness to pay for malaria diagnosis noted above
Summary
In Uganda, as in most other malaria-endemic countries, presumptive treatment for malaria based on symptoms without a diagnostic blood test is still very common. While diagnostic testing in public sector facilities is increasing, many people in Uganda who suspect malaria visit private sector outlets to purchase medications. A study from six African countries found that only 2 to 16% of children with febrile illnesses received a malaria blood test in the private sector prior to treatment [9]. Treatment-seeking in the retail sector is common because health facilities are often distant, with limited staff, long wait times, limited hours, and frequent stock-outs of essential medicines. Even when fees at public health facilities are low, visits to private or informal drug shops are common due to their convenience and accessibility [12]
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