Improving Access to Malaria Rapid Diagnostic Test in Niger State, Nigeria: An Assessment of Implementation up to 2013

Abstract

Nigeria's 2009–2013 malaria strategic plan adopted WHO diagnosis and treatment guidelines, which include the use of rapid diagnostic tests (RDTs) prior to prescribing treatment with artemisinin combination therapies (ACTs). The current study explores accessibility barriers to the use of RDTs in Niger State and makes recommendations for improving the uptake of RDTs. The study employs literature review, review of data from the Niger State Health Management Information System for January–October 2013, and application of Peters' conceptual framework for assessing access to health services. Data showed that 27 percent of public health facilities (HFs) implemented RDTs, with the aid of donor funds. In these facilities, 77 percent of fever cases presented during the study period were tested with RDTs; 53 percent of fever cases were confirmed cases of malaria, while 60 percent of fever cases were treated. Stockouts of RDTs were a major constraint, and severe fever tended to trigger presumptive treatment. We conclude that although implementation of RDTs led to a reduction in the use of ACTs at HFs, more substantial reduction could be achieved if the state government directed more resources towards the acquisition of RDTs as well as raising the level of awareness of potential users.

Examining Public Sector Availability and Supply Chain Management Practices for Malaria Commodities: Findings From Northern Nigeria

“…Earlier studies conducted in Nigeria have reported varying rates of malaria commodity stock-outs. 30 , 31 For example, all public health facilities in Niger State were stocked out of mRDTs in the first quarter of 2012, with a stock-out rate of 76% or more for ACTs in the first 2 months of the same year. 30 A 2014 assessment across 252 health facilities in Nigeria yielded a stock-out rate of 28% for AL1, 32 which is considerably lower than our finding, suggesting that the malaria commodity availability situation has worsened since then.…”

“… 30 , 31 For example, all public health facilities in Niger State were stocked out of mRDTs in the first quarter of 2012, with a stock-out rate of 76% or more for ACTs in the first 2 months of the same year. 30 A 2014 assessment across 252 health facilities in Nigeria yielded a stock-out rate of 28% for AL1, 32 which is considerably lower than our finding, suggesting that the malaria commodity availability situation has worsened since then. The disproportionate availability of AL when compared with AA could negatively impact the implementation of multiple first-line therapies, a desired strategy to increase the therapeutic life of most ACTs.…”

Effectiveness of antimalarial interventions in Nigeria: Evidence from facility‐level longitudinal data

“…Through nationwide health care reforms, malaria treatment in public facilities has been subsidized since 2010. 18 In August 2010-March 2016, with assistance from international donors, the Niger State government was able to adopt the WHO's guidelines for malaria control, 3 and implement a program of antimalarial interventions, providing free antimalarial services and commodities at selected health facilities.…”

“…WITVORAPONG ANd YAKUBU health personnel in malaria control, 3 and social insensitivities in the delivery of antimalarial services. 5 One of the most important barriers remains financial; 6,7 poorer households are unable to obtain antimalarial services, despite their availability, physical accessibility, and social acceptability.…”