Knowledge, attitudes and practices towards malaria diagnostics among healthcare providers and healthcare-seekers in Kondoa district, Tanzania: a multi-methodological situation analysis

Abstract

Background Despite the large-scale rollout of malaria rapid diagnostic tests (RDTs) in Tanzania, many healthcare providers (HCPs) continue using blood film microscopy (BFM) and clinical examination to diagnose malaria, which can increase the risk of mal-diagnosis and over-prescribing of anti-malarials. Patients disregarding negative test results and self-treating exacerbate the problem. This study explored the knowledge, attitudes and practices of HCPs and healthcare-seekers regarding RDTs in comparison to BFM testing. Methods A situational analysis was, therefore, conducted in Kondoa District, Dodoma Region, Tanzania. A multi-methodological approach was adopted including (i) a health facility inventory and screening of logbooks from May 2013 to April 2014 with 77,126 patient entries from 33 health facilities; (ii) a survey of 40 HCPs offering malaria services; and iii) a survey of 309 randomly selected household members from the facilities’ catchment area. Surveys took place in April and May 2014. Results Health facility records revealed that out of 77,126 patient entries, 22% (n = 17,235) obtained a malaria diagnosis. Of those, 45% were made with BFM, 33% with RDT and 22% with clinical diagnosis. A higher rate of positive diagnoses was observed with BFM compared with RDT (71% vs 14%). In the HCP survey, 48% preferred using BFM for malaria testing, while 52% preferred RDT. Faced with a negative RDT result for a patient presenting with symptoms typical for malaria, 25% of HCPs stated they would confirm the result with a microscopy test, 70% would advise or perform a clinical diagnosis and 18% would prescribe anti-malarials. Interviews with household members revealed a preference for microscopy testing (58%) over RDT (23%), if presented with malaria symptoms. For participants familiar with both tests, a second opinion was desired in 45% after a negative microscopy result and in 90% after an RDT. Conclusions Non-adherence to negative diagnostics by HCPs and patients continues to be a concern. Frequent training and supportive supervision for HCPs diagnosing and treating malaria and non-malaria febrile illnesses is essential to offer quality services that can instil confidence in HCPs and patients alike. The introduction of new diagnostic devices should be paired with context-specific behaviour change interventions targeting healthcare-seekers and healthcare providers.

Perceptions and drivers of healthcare provider and drug dispenser practices for the case management of malaria in pregnancy in the context of multiple first-line therapies in western Kenya: a qualitative study

“…Presumptive treatment of malaria in pregnant women with clinical symptoms emerged as a common practice. This has previously been documented in Kenya and other countries [30][31][32][33][34]. Women's hesitancy to be tested with a malaria RDT due to association with HIV testing has not been described previously, though women's concerns about fears of HIV testing hampering intermittent preventive treatment (IPTp) uptake in antenatal clinics have been documented [35].…”

Developing the OpenFlexure Microscope towards medical use: Technical and social challenges of developing globally accessible hardware for healthcare

“…However, limited access to high-quality, well-maintained microscopes and trained users restricts the accessibility of these tests. A survey of Tanzanian health clinics reported that only 42% had access to a light microscope for malaria diagnosis, dropping to just 20% of public health facilities [8]. Furthermore, there is a workforce shortage across pathology services worldwide [9].…”

Developing the OpenFlexure Microscope towards medical use: technical and social challenges of developing globally accessible hardware for healthcare

“…However, limited access to high-quality, well-maintained microscopes and trained users restricts the accessibility of these tests. A survey of Tanzanian health clinics reported that only 42% had access to a light microscope for malaria diagnosis, dropping to just 20% of public health facilities [8]. Furthermore, there is a worldwide workforce shortage across pathology services [9].…”