Abstract
IntroductionContrary to World Health Organizations recommendations, health workers (HWs) still prescribe antimalarials to malaria rapid diagnostic test (mRDT)-negative patients, thus increasing overuse and the risk of parasite resistance to the antimalarials. The reasons for this are not clear. We identified factors associated with antimalarial prescription to mRDT-negative patients.MethodsWe conducted a cross-sectional study among 423 HWs. Data on socio-demographic characteristics, training, supervision experience and fever management practices were collected. We tested associations between independent variables and prescription of antimalarials to mRDT-negative patients using Chi square and logistic regression at p < 0.05.ResultsThe HWs were mostly community health workers (58.6%), with mean age of 41.0 (±8.8) years and 13.6 (± 9.0) years of professional practice. Females were 322 (76.1%) and 368 (87%) were married. Of the 423 HWs interviewed, 329 (77.8%) received training on mRDT use, 329 (80.6%) received supervision and 129 (30.5%) had good knowledge of causes of fever. Overall, 110 (26.0%) of the HWs prescribed antimalarials to mRDT-negative patients. A higher proportion of non-trained vs trained HWs [Adjusted Odds Ratio (aOR) = 4.9; 95% Confidence Interval (CI) (2.5-8.3)], and HWs having poor knowledge vs HWs having good knowledge of causes of fever [aOR = 1.9; 95% CI (1.0-3.5)], prescribed antimalarials to mRDT-negative patients.ConclusionHWs' lack of training on mRDT use and poor knowledge of causes of fever were associated with prescription of antimalarials to mRDT-negative patients. We recommend training on management of fever and mRDT use to reduce such inappropriate antimalarial prescriptions.
Highlights
Contrary to World Health Organizations recommendations, health workers (HWs) still prescribe antimalarials to malaria rapid diagnostic test-negative patients, increasing overuse and the risk of parasite resistance to the antimalarials
The age of health workers, marital status, duration of professional practice, ownership of health facility where health workers practice, level of care of facility, location of facility, training on use of RDT in malaria case management, health worker's knowledge of causes of fever and health workers experience with supportive supervision showed statistically significant association with prescription of antimalarial drugs to malaria RDT negative patients (Table 2)
After controlling for confounders, only lack of previous training on malaria rapid diagnostic test (mRDT) use and poor knowledge of causes of fever were independently associated with prescription of antimalarial medicine to mRDT negative patients. (Table 3)
Summary
Contrary to World Health Organizations recommendations, health workers (HWs) still prescribe antimalarials to malaria rapid diagnostic test (mRDT)-negative patients, increasing overuse and the risk of parasite resistance to the antimalarials. The reasons for this are not clear. The development of the malaria rapid diagnostic test (mRDT) has increased the opportunity for parasitological diagnosis of malaria where microscopy is not available They neither require the use of specialized equipment, specialized training nor electricity [6]. We conducted a quantitative survey to assess the treatment practices of health workers for mRDT-negative patients in Oyo State and to identify the factors associated with prescribing antimalarial medicine to such patients
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