Abstract
The standard practice in treating uncomplicated malaria is to prescribe artemisinin-based combination therapy (ACT) for only patients with positive test results. However, health workers (HWs) sometimes prescribe ACTs for patients with negative malaria rapid diagnostic test (mRDT) results. Available evidence on HWs perception of mRDT and their level of compliance with test results in Nigeria lacks adequate stratification by state and context. We assessed HWs perception of mRDT and factors influencing ACTs prescription to patients with negative mRDT results in Ebonyi state, Nigeria. A cross-sectional survey was conducted among 303 HWs who treat suspected malaria patients in 40 randomly selected public and private health facilities in Ebonyi state. Health workers' perception of mRDT was assessed with 18 equally weighted five-point likert scale questions with maximum obtainable total score of 90. Scores ≥72 were graded as good and less, as poor perception. Data were analysed using descriptive statistics and logistic regression model at 5% significance level. Mean age of respondents was 34.6±9.4 years, 229 (75.6%) were females, 180 (59.4%) community health workers and 67 (22.1%) medical doctors. Overall, 114 (37.6%) respondents across healthcare facility strata had poor perception of mRDT. Respondents who prescribed ACTs to patients with negative mRDT results within six months preceding the survey were 154 (50.8%) [PHCs: 50 (42.4%), General hospitals: 18 (47.4%), tertiary facility: 51 (79.7%) and missionary hospitals: 35 (42.2%)]. Poor HWs' perception of mRDT promoted prescription of ACT to patients with negative mRDT results (AOR = 5.6, 95% C.I = 3.2-9.9). The likelihood of prescribing ACTs to patients with negative mRDT results was higher among HWs in public health facilities (AOR = 2.8, 95% C.I = 1.4-5.5) than those in the private. The poor perception of mRDT and especially common prescribing of ACTs to patients with negative mRDT results among HWs in Ebonyi state calls for context specific interventions to improve their perception and compliance with mRDT test results.
Highlights
Malaria is an important health threat with about 219 million cases and 435,000 associated deaths in the year 2017, approximately 92% of the cases and 93% of the deaths occurred in sub-Saharan Africa [1]
MRDT is used for malaria diagnosis at the children outpatient (CHOP), children emergency (CHER), and a model comprehensive healthcare center located at Izzi local government areas (LGAs) which serves a rural outpost for the tertiary facility
The average number of HWs licensed to treat patients in the different strata of healthcare facilities in the state are as follows: four community health workers (CHWs) in each PHC, six in each General hospital, about 30 in each missionary hospital and 80 in the departments of the tertiary facility where malaria rapid diagnostic test (mRDT) is used for malaria diagnosis
Summary
Malaria is an important health threat with about 219 million cases and 435,000 associated deaths in the year 2017, approximately 92% of the cases and 93% of the deaths occurred in sub-Saharan Africa [1]. It is currently recommended that every suspected malaria case be confirmed using light microscopy (gold standard) or Rapid Diagnostic Test (RDT) before treatment [4,5,6,7]. Operational complexities such as erratic electric power supply and dearth of expert malaria microscopists, have limited the use of light microscopy in malaria endemic countries like Nigeria. Health workers (HWs) sometimes prescribe ACTs for patients with negative malaria rapid diagnostic test (mRDT) results. We assessed HWs perception of mRDT and factors influencing ACTs prescription to patients with negative mRDT results in Ebonyi state, Nigeria
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