Abstract
BackgroundThe World Health Organization now recommends parasitological confirmation for malaria case management. Rapid diagnostic tests (RDTs) for malaria are an accurate and simple diagnostic to confirm parasite presence in blood. However, where they have been deployed, adherence to RDT results has been poor, especially when the test result is negative. Few studies have examined adherence to RDTs distributed or purchased through the private sector.MethodsThe Rapid Examination of Malaria and Evaluation of Diagnostic Information (REMEDI) study assessed the acceptability of and adherence to RDT results for patients seeking care from private sector drug retailers in two cities in Oyo State in south-west Nigeria. In total, 465 adult participants were enrolled upon exit from a participating drug shop having purchased anti-malaria drugs for themselves. Participants were given a free RDT and the appropriate treatment advice based on their RDT result. Short Message Service (SMS) text messages reiterating the treatment advice were sent to a randomly selected half of the participants one day after being tested. Participants were contacted via phone four days after the RDT was conducted to assess adherence to the RDT information and treatment advice.ResultsAdherence to RDT results was 14.3 percentage points (P-val <0.001) higher in the treatment group who were sent the SMS. The higher adherence in the treatment group was robust to several specification tests and the estimated difference in adherence ranged from 9.7 to 16.1 percentage points. Further, the higher adherence to the treatment advice was specific to the treatment advice for anti-malarial drugs and not other drugs purchased to treat malaria symptoms in the RDT-negative participants who bought both anti-malarial and symptom drugs. There was no difference in adherence for the RDT-positive participants who were sent the SMS.ConclusionsSMS text messages substantially increased adherence to RDT results for patients seeking care for malaria from privately owned drug retailers in Nigeria and may be a simple and cost-effective means for boosting adherence to RDT results if and when RDTs are introduced as a commercial retail product.
Highlights
The World Health Organization recommends parasitological confirmation for malaria case management
The protocol entailed 1) enrolling non-pregnant adults outside of a pharmacy/ drug shop who stated and demonstrated that they had just purchased malaria treatment for him/herself; 2) offering and conducting an Rapid diagnostic tests for malaria (RDT) performed by a trained nurse; 3) taking a detailed survey and inventory of drugs purchased; 4) discussing the test result with the patient; and 5) providing appropriate treatment advice based on the test result at the end of the survey
A simple comparison of means shows that 79.8% of participants who were sent an Short Message Service (SMS) adhered to the treatment advice compared to only 65.5% who were not sent an SMS
Summary
The World Health Organization recommends parasitological confirmation for malaria case management. Rapid diagnostic tests (RDTs) for malaria are an accurate and simple diagnostic to confirm parasite presence in blood. Where they have been deployed, adherence to RDT results has been poor, especially when the test result is negative. Recent World Health Organization guidelines for malaria management in endemic countries recommend that treatment should be reserved for confirmed malaria cases [1], presumptive diagnosis of malaria and subsequent over-administration of anti-malarial drugs remain the norm [2]. When RDT-negative patients disregard RDT results, the potential of RDTs to increase the cost-effectiveness of malaria treatment is undermined because 1) savings from unnecessary treatments are not realized, and 2) over-administration of first-line anti-malarial drugs may fuel parasite resistance and/or diminished efficacy over time
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