Abstract
BackgroundNigeria commenced a phased programmatic deployment of rapid diagnostic tests (RDT) at the primary health care (PHC) facility levels since 2011. Despite various efforts, the national testing rate for malaria is still very low. The uptake of RDT has been variable. This study was undertaken to determine the provider and patient perceptions to RDT use at the PHC level in Nigeria with their implications for improving uptake and compliance.MethodsA cross-sectional survey was conducted in 120 randomly selected PHCs across six states, across the six-geopolitical zones of Nigeria in January 2013. Health facility staff interviews were conducted to assess health workers (HW) perception, prescription practices and determinants of RDT use. Patient exit interviews were conducted to assess patient perception of RDT from ten patients/caregivers who met the eligibility criterion and were consecutively selected in each PHC, and to determine HW’s compliance with RDT test results indirectly. Community members, each selected by their ward development committees in each Local Government Area were recruited for focus group discussion on their perceptions to RDT use.ResultsHealth workers would use RDT results because of confidence in RDT results (95.4%) and its reduction in irrational use of artemisinin-based combination therapy (ACT) (87.2%). However, in Enugu state, RDT was not used by health workers because of the pervasive notion RDT that results were inaccurate. Among the 1207 exit interviews conducted, 549 (45.5%) had received RDT test. Compliance rate (administering ACT to positive patients and withholding ACT from negative patients) from patient exit interviews was 90.2%. Among caregivers/patients who had RDT done, over 95% knew that RDT tested for malaria, felt it was necessary and liked the test. Age of patients less than 5 years (p = 0.04) and “high” educational status (p = 0.0006) were factors influencing HW’s prescription of ACT to RDT negative patients.ConclusionThe study demonstrated positive perception to RDT use by HW and among community members with good compliance rate among health workers at the PHC level. This positive perception should be explored in improving the current low level of malaria testing in Nigeria while addressing the influence of age on HW administration of ACT to RDT negative cases.
Highlights
Nigeria commenced a phased programmatic deployment of rapid diagnostic tests (RDT) at the primary health care (PHC) facility levels since 2011
Health workers knowledge and perception of RDTs The 120 health workers interviewed had all been previously trained on malaria case management
Reasons given were that they have confidence in the results (95.4%), it would reduce the unnecessary use of artemisinin-based combination therapy (ACT) (87.2%), permit the consideration of other conditions (67.9%) and because it gave them more confidence than microscopy results (43.1%)
Summary
Nigeria commenced a phased programmatic deployment of rapid diagnostic tests (RDT) at the primary health care (PHC) facility levels since 2011. Rapid diagnostic tests (RDTs) have been found useful as a rapid diagnostic measure in the management of malaria [11, 13] Their use has reduced the unnecessary administration of anti-malarial medicines and the early diagnosis of other non-malaria illnesses reducing treatment cost and morbidity and mortality [12]. Consistent with global best practices and World Health Organization (WHO) recommendations, Nigeria recently updated its guidelines recommending universal testing before treatment [8]. This imposes the need to make diagnostic tools available as peripherally as possible. Deployment of RDTs at primary health centres have been reported elsewhere to be plagued with the ambiguity of policy and abiding mistrust of the efficacy of RDTs to detect malaria resulting in poor compliance to the clinical guidelines for malaria case management following negative RDT results [13,14,15]
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