Status of the use and compliance with malaria rapid diagnostic tests in formal private health facilities in Nigeria

Abstract

Background Nigeria has the largest number of malaria-related deaths, accounting for a third of global malaria deaths. It is important that the country attains universal coverage of key malaria interventions, one of which is the policy of universal testing before treatment, which the country has recently adopted. However, there is a dearth of data on its implementation in formal private health facilities, where close to a third of the population seek health care. This study identified the level of use of malaria rapid diagnostic testing (RDT), compliance with test results and associated challenges in the formal private health facilities in Nigeria.Methods A cross-sectional study that involved a multi-stage, random sampling of 240 formal private health facilities from the country’s six geo-political zones was conducted from July to August 2014. Data were collected using health facility records, healthcare workers’ interviews and an exit survey of febrile patients seen at the facilities, in order to determine fever prevalence, level of testing of febrile patience, compliance with test results, and health workers’ perceptions to RDT use.ResultsData from the 201 health facilities analysed indicated a fever prevalence of 38.5 % (112,521/292,430). Of the 2077 exit interviews for febrile patients, malaria testing was ordered in 73.8 % (95 % CI 71.7–75.7 %). Among the 1270 tested, 61.8 % (719/1270) were tested with microscopy and 38.2 % (445/1270) with RDT. Compliance to malaria test result [administering arteminisin-based combination therapy (ACT) to positive patients and withholding ACT from negative patients] was 80.9 % (95 % CI 78.7–83 %). Compliance was not influenced by the age of patients or type of malaria test. The health facilities have various cadres of the health workers knowledgeable on RDT with 70 % knowing the meaning, while 84.5 % knew what it assesses. However, there was clearly a preference for microscopy as only 20 % reported performing only RDT.ConclusionIn formal private health facilities in Nigeria there is a high rate of malaria testing for febrile patients, high level of compliance with test results but relatively low level of RDT utilization. This calls for improved engagement of the formal private health sector with a view to achieving universal coverage targets on malaria testing.

Predictors of Malaria Rapid Diagnostic Tests’ Utilisation Among Healthcare Workers in Zamfara State

“…The study showed that healthcare workers have good knowledge of mRDT similar to a study conducted in Southeast Nigeria where 61.1% of respondents knew about mRDT. 24 The proportion of healthcare workers who knew the meaning of mRDT was found to be higher than that in a study carried out in the six geo-political zones of Nigeria where 70% reported knowing the meaning of mRDT 21 . This is probably because of investment by government and non-governmental organizations in awareness creation on parasitological testing through training on mRDT 21 in Zamfara state.…”

“…Factors such as heavy workload, lack of trust, cost, training on the use of RDTs have been considered to influence RDT use 16–21 . A study reported a high proportion (61.5%) of healthcare workers perceived mRDTs as unreliable, one-third (30.8%) of healthcare workers had supply issues with mRDT, 15.4% of them reported a preference for other methods of malaria diagnosis and one-fifth (26%) of healthcare workers were ignorant about mRDT.…”

A Socio-Ecological Approach To Understanding The Factors Influencing The Uptake Of Intermittent Preventive Treatment Of Malaria In Pregnancy (IPTp) In South Western Nigeria.

“…We purposively selected public healthcare providers (4), TBAs (4) and faith-based birth attendants (4) based on popularity and accessibility within selected communities, to explore access and awareness surrounding IPTp in a pluralistic health sector. We further purposively contacted community leaders (7) and caregivers, mainly, family members (20), through participating pregnant women (30), to enable us to explore the in uence of community and family networks on IPTp access and uptake. SSIs were conducted in the local language (Yoruba) and/or English with each interview ranging from 30 to 65 minutes.…”

“…However, there is scant evidence on how interpersonal, societal and provider related factors contribute to the poor uptake of ITNs and IPTp, particularly in rural and lower socioeconomic communities where social and communal norms are most in uential. This is relevant as Nigeria operates a pluralistic health sector with about 60% of Nigerians seeking private health care (7,8). Traditional Birth Attendants (TBAs) and faith-based birth attendants, as key parts of the private health sector, provide a signi cant amount of ANC services (9,10), especially in rural and lower socio-economic communities.…”

The Nigerian health information system policy review of 2014 : the need, content, expectations and progress

“…However, its underperformance can be catastrophic resulting in biased investments, planning and poor health outcomes. Studies have shown the RHIS in Nigeria to be inadequate to support mental health, maternal and child health, malaria, and disease surveillance decisions (Makinde, ; Mokuolu et al., ; Nnebue, Onwasigwe, Ibeh, & Adogu, ; Upadhaya et al., ; Wollum, Burstein, Fullman, Dwyer‐Lindgren, & Gakidou, ). Efforts aimed at addressing the RHIS are exploring the deployment of mobile enabled applications to improve the timeliness and completeness of reports (Asangansi & Braa, ; Asangansi et al., ).…”