Abstract
BackgroundThe success of the universal parasite-based malaria testing policy for fever patients attending primary health care (PHC) facilities in Tanzania will depend highly on health workers’ perceptions and practices. The aim of this study was, therefore, to assess the present use of malaria diagnostics (rapid diagnostic tests (RDTs) and microscopy), prescription behaviour and factors affecting adherence to test results at PHC facilities in Kibaha District, Coast Region, Tanzania.MethodsExit interviews were conducted with fever patients at PHC facilities and information on diagnostic test performed and treatment prescribed were recorded. Interviews with prescribers to assess their understanding, perceptions and practices related to RDTs were conducted, and health facility inventory performed to assess availability of staff, diagnostics and anti-malarial drugs.ResultsThe survey was undertaken at ten governmental PHC facilities, eight of which had functional diagnostics. Twenty health workers were interviewed and 195 exit interviews were conducted with patients at the PHC facilities. Of the 168 patients seen at facilities with available diagnostics, 105 (63%) were tested for malaria, 31 (30%) of whom tested positive. Anti-malarial drugs were prescribed to all patients with positive test results, 14% of patients with negative results and 28% of patients not tested for malaria. Antibiotics were more likely to be prescribed to patients with negative test results compared to patients with positive results (81 vs 39%, p < 0.01) and among non-tested compared to those tested for malaria (84 vs 69%, p = 0.01). Stock-outs of RDTs and staff shortage accounted for the low testing rate, and health worker perceptions were the main reason for non-adherence to test results.ConclusionsAnti-malarial prescription to patients with negative test results and those not tested is still practiced in Tanzania despite the universal malaria testing policy of fever patients. The use of malaria diagnostics was also associated with higher prescription of antibiotics among patients with negative results. Strategies to address health system factors and health worker perceptions associated with these practices are needed.
Highlights
The success of the universal parasite-based malaria testing policy for fever patients attending primary health care (PHC) facilities in Tanzania will depend highly on health workers’ perceptions and practices
Eight study sites were equipped with parasite-based diagnostics at the time of survey, of which five used rapid diagnostic tests (RDTs) and three microscopy
Prescription of antibiotics was higher among patients who tested negative for malaria than those with positive results (81 vs 39%, p < 0.01), and among those not tested compared to those tested for malaria (84 vs 69%, p = 0.01)
Summary
The success of the universal parasite-based malaria testing policy for fever patients attending primary health care (PHC) facilities in Tanzania will depend highly on health workers’ perceptions and practices. Development and spread of ACT resistance may have drastic consequences for the recent malaria control achievements. For this reason it has become increasingly important to change from symptom-based presumptive treatment to parasitological confirmation of malaria infection before initiation of anti-malarial treatment. WHO recommends that anti-malarial treatment be confined to laboratory confirmed cases only [5], and the availability of rapid diagnostic tests (RDTs) offers a good opportunity to extend parasitological confirmation of malaria infection to peripheral areas where quality microscopy cannot be guaranteed [6,7]
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