The Accuracy and Perception of Test-Based Management of Malaria at Private Licensed Chemical Shops in the Middle Belt of Ghana

Abstract

The sale of artemisinin-based combination therapy (ACT) by private licensed chemical shops (LCS) without testing is contrary to current policy recommendations. This study assessed the accuracy and perception of test-based management of malaria using malaria rapid diagnostic test (mRDT) kits at private LCS in two predominantly rural areas in the middle part of Ghana. Clients presenting at LCS with fever or other signs and symptoms suspected to be malaria in the absence of signs of severe malaria were tested with mRDT by trained attendants and treated based on the national malaria treatment guidelines. Using structured questionnaires, exit interviews were conducted within 48 hours and a follow-up interview on day 7 (±3 days). Focus group discussions and in-depth interviews were also conducted to assess stakeholders' perception on the use of mRDT at LCS. About 79.0% (N = 1,797) of clients reported with a fever. Sixty-six percent (947/1,426) of febrile clients had a positive mRDT result. Eighty-six percent (815/947) of clients with uncomplicated malaria were treated with the recommended ACT. About 97.8% (790/808) of clients with uncomplicated malaria treated with ACT were reported to be well by day 7. However, referral for those with negative mRDT results was very low (4.1%, 27/662). A high proportion of clients with a positive mRDT result received the recommended malaria treatment. Testbased management of malaria by LCS attendants was found to be feasible and acceptable by the community members and other stakeholders. Successful implementation will however require effective referral, supervision and quality control systems.

Public Health Interventions Delivered by Pharmacy Professionals in Low- and Middle-Income Countries in Africa: A Systematic Scoping Review

“…A total of twelve studies, from seven countries, that examined the service provision of pharmacy professionals in the infectious disease theme were identified [ 25 , 26 , 27 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ]. Malaria, diarrheal disease, and tuberculosis were the primary targets of the interventions.…”

“…The level C evidence centered on the pharmacy professional-led screening and management of infections and NCDs [ 20 , 25 , 28 , 45 , 51 , 54 , 55 ], antimicrobial stewardship programs [ 62 , 63 , 64 , 65 ], and emergency contraception supply [ 23 ]. The majority of the studies generating level D evidence utilized surveys, with or without mystery patient methodology, to examine the actual practice of pharmacy service provision, while a few used qualitative interviews or focus group discussions with mystery patient methodology [ 18 , 19 , 21 , 22 , 24 , 26 , 27 , 43 , 44 , 46 , 47 , 48 , 49 , 50 , 53 , 56 , 57 , 59 , 60 , 61 , 66 , 67 , 68 , 69 , 70 ]. One-quarter of the included studies ( n = 9) examined processes such as acceptability and feasibility of specific services [ 20 , 25 , 44 , 45 , 47 , 54 , 59 , 68 , 70 ].…”

“…The majority of the studies generating level D evidence utilized surveys, with or without mystery patient methodology, to examine the actual practice of pharmacy service provision, while a few used qualitative interviews or focus group discussions with mystery patient methodology [ 18 , 19 , 21 , 22 , 24 , 26 , 27 , 43 , 44 , 46 , 47 , 48 , 49 , 50 , 53 , 56 , 57 , 59 , 60 , 61 , 66 , 67 , 68 , 69 , 70 ]. One-quarter of the included studies ( n = 9) examined processes such as acceptability and feasibility of specific services [ 20 , 25 , 44 , 45 , 47 , 54 , 59 , 68 , 70 ]. Almost half of the studies ( n = 17) reported that public health services offered by pharmacy professionals were of poor quality and had low success rates, indicating structural and institutional barriers to their implementation [ 18 , 19 , 21 , 23 , 24 , 26 , 47 , 48 , 49 , 50 , 53 , 60 ,…”

“…They were also trained in the appropriate testing and treatment of malaria, pneumonia, and diarrhea in the infectious disease studies. The training covered disease signs and symptoms [ 54 , 55 , 58 , 59 ], how to perform Rapid Diagnostic Testing [ 25 , 54 , 57 , 59 ], how to take a blood sample and make a blood slide [ 58 ], blood safety, and sharp objects handling [ 58 ], infection prevention procedures [ 58 ], referral of patients [ 54 , 58 , 59 ], treatment with combination drugs [ 25 , 54 , 55 , 57 , 58 , 59 ], and malaria drug policy [ 58 ]. In the sexual and reproductive health studies, they were trained in client engagement [ 70 ], provision of family planning methods [ 22 , 23 , 68 ], referring clients for injection [ 68 , 70 ] or other methods of contraception or complications [ 22 , 23 ], recording of service utilization [ 68 ], and collecting client information [ 68 ], using a variety of learning methodologies, including demonstration, group discussion, and role-play simulations.…”

Exploring the knowledge, attitude, and practices of over-the-counter medical sellers in Ghana

“…Recent studies describe dermatologic conditions as the fourth leading cause of morbidity worldwide 19 , with a significant impact on both quality of life 20,21 and socioeconomic costs 22,23,24 . In Ghana, specialized OTCMS programs recently showed increased efficacy in managing novel medical applications in rural Ghana, exemplified in programs for contraception 25 and malaria 26 . These exceptions have shown improved healthcare metrics both in public health and economic impact and, if similarly applied to dermatologic disease, might theoretically equally improve the management of skin conditions in rural Ghana, including the ability of OTCMS to manage these pathologies in areas with little-to-no dermatologists.…”