BackgroundRapid diagnostic tests (RDTs) and Artemisinin-based combination therapy (ACT) have been widely advocated by government and the international community as cost-effective tools for diagnosis and treatment of malaria. ACTs are now the first line treatment drug for malaria in Nigeria and RDTs have been introduced by the government to bridge the existing gaps in proper diagnosis. However, it is not known how readily available these RDTs and ACTs are in public and private health facilities and whether health workers are actually using them. Hence, this study investigated the levels of availability and use of RDTs and ACTs in these facilities.MethodsThe study was undertaken in Enugu state, southeast Nigeria in March 2009. Data was collected from heads of 74 public and private health facilities on the availability and use of RDTs and ACTs. Also, the availability of RDTs and the types of ACTs that were available in the facilities were documented.ResultsOnly 31.1% of the health facilities used RDTs to diagnose malaria. The majority used the syndromic approach. However, 61.1% of healthcare providers were aware of RDTs. RDTs were available in 53.3% of the facilities. Public health facilities and health facilities in the urban areas were using RDTs more and these were mainly bought from pharmacy shops and supplied by NGOs. The main reasons given for non use are unreliability of RDTs, supply issues, costs, preference for other methods of diagnosis and providers' ignorance. ACTs were the drug of choice for most public health facilities and the drugs were readily available in these facilities.ConclusionAlthough many providers were knowledgeable about RDTs, not many facilities used it. ACTS were readily available and used in public but not private health facilities. However, the reported use of ACTs with limited proper diagnosis implies that there could be high incidence of inappropriate case management of malaria which can also increase the economic burden of illnesses. Government and donors should ensure constant availability of RDTs in both public and private facilities, so that every treatment with ACTs is accompanied with proper diagnosis.

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.

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Objectives:The study determined the levels of geographic differences in the utilization of routine immunization between households in an urban and a rural community. It also identified and compared the determinants of utilization of routine immunization in the two geographic areas.Method:The study was undertaken in two randomly selected communities (one rural and one urban) in Anambra State, Nigeria. Interviewer-administered questionnaires were used to collect information on utilization of immunization services from households. Data were analyzed using descriptive and multiple logistic regression analyses.Result:Households in the urban community had a higher level of utilization of routine immunization (95.5%) than those in the rural community (75.3%) and the difference was statistically significant (p < 0.05). It was also found that more rural dwellers (83.3%) received immunization services from public health facilities compared to the urban dwellers (42%; p < 0.05). Health facilities were nearer to households in the urban community than the rural community (p < 0.05). Mean cost of service per visit was higher in the urban community (p < 0.05), but the difference in the mean cost of transportation per visit was not significant (p = 0.125). Regression analysis shows that place of residence was highly significant for utilization of routine immunization services (p < 0.05).Conclusion:Urban–rural differences exist in utilization of routine immunization services. Health facilities are more proximal to consumers in the urban community than the rural community, with higher travel costs among rural dwellers. Ensuring that there is a functional primary healthcare center in every ward and provision of routine immunization services in market places on local market days can help to increase utilization and reduce rural–urban differences in utilization of immunization services.