Abstract
IntroductionDevelopments in rapid diagnostic tests (RDTs) have opened new possibilities for improved remote malaria diagnosis that is independent of microscopic diagnosis. Studies in some settings have tried to assess the influence of RDTs on the prescribing behaviour of health workers, but such information is generally lacking in Nigeria and many parts of sub-Saharan Africa. This study analysed health workers' perceptions of RDTs and their potential influence on their prescribing and treatment practices after their introduction.MethodsThe study was conducted in four health centers in the Enugu East local government of Enugu State, Nigeria. All 32 health workers in the health centers where RDTs were deployed were interviewed by field workers. Information was sought on their perception of symptoms-based, RDT-based, and microscopy-based malaria diagnoses. In addition, prescription analysis was carried out on 400 prescriptions before and 12 months after RDT deployment.ResultsThe majority of the health workers perceived RDTs to be more effective for malaria diagnosis than microscopy and clinical diagnosis. They also felt that the benefits of RDTs included increased use of RDTs in the facilities and the tendency to prescribe more Artemisinin-based combination therapies (ACTs) and less chloroquine and SP. Some of the health workers experienced some difficulties in the process of using RDT kits. ACTs were prescribed in 74% of RDT-negative results.Conclusions/SignificanceRDT-supported malaria diagnosis may have led to the overprescription of ACTs, with the drug being prescribed to people with RDT-negative results. However, the prescription of other antimalarial drugs that are not first-line drugs has been reduced. Efforts should be made to encourage health workers to trust RDT results and prescribe ACTs only to those with positive RDT results. In-depth studies are needed to determine why health workers continue to prescribe ACTs in RDT-negative results.
Highlights
Developments in rapid diagnostic tests (RDTs) have opened new possibilities for improved remote malaria diagnosis that is independent of microscopic diagnosis
They felt that the benefits of RDTs included increased use of RDTs in the facilities (24, 75.0%) and the tendency to prescribe more Artemisinin-based combination therapies (ACTs) (25, 78.1%) and less chloroquine (13, 40.6%)
If RDTs are to be effective in malaria programmes, the need to manage RDT-negative results should be addressed; otherwise, health workers will continue to treat many cases of non-malarial fever with ACTs, and the potential benefit of malaria RDTs in improving the early management of non-malarial febrile illness through early diagnosis and exclusion of malaria as a cause would be lost
Summary
Developments in rapid diagnostic tests (RDTs) have opened new possibilities for improved remote malaria diagnosis that is independent of microscopic diagnosis. Studies in some settings have tried to assess the influence of RDTs on the prescribing behaviour of health workers, but such information is generally lacking in Nigeria and many parts of subSaharan Africa. Clinical diagnosis based on malaria symptoms has proven to be unspecific [9,10,11] These shortcomings of microscopy and clinical diagnosis have favoured the deployment and use of RDTs, which allows diagnosis even in health settings lacking any laboratory facility. RDTs have been found to be cost-effective both in Nigeria and elsewhere [12,13,14,15,16], and they generally cost less than a full course of ACT Their introduction should improve malaria management but should limit malaria treatment costs [17]. An ACT (dihydroxy-artemisinin/piperaquine) was introduced to complement the RDTs
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