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Mokuolu OA, Ntadom GN, Ajumobi OO, Alero RA, Wammanda RD, Adedoyin OT, Okafor HU, Alabi AD, Odey FA, Agomo CO, Edozieh KU, Fagbemi TO, Njidda AM, Babatunde S, Agbo EC, Nwaneri NB, Shekarau ED, Obasa TO, Ezeigwe NM. Status of the use and compliance with malaria rapid diagnostic tests in formal private health facilities in Nigeria. Malar J 2016; 15:4. [PMID: 26728037 PMCID: PMC4700573 DOI: 10.1186/s12936-015-1064-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/22/2015] [Indexed: 11/17/2022] Open
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. Results Data 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. Conclusion In 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.
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Affiliation(s)
- Olugbenga A Mokuolu
- Department of Paediatrics and Child Health, College of Health Sciences, University of Ilorin, Ilorin, Kwara, Nigeria.
| | - Godwin N Ntadom
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria.
| | - Olufemi O Ajumobi
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria.
| | | | | | - Olanrewaju T Adedoyin
- Department of Paediatrics and Child Health, College of Health Sciences, University of Ilorin, Ilorin, Kwara, Nigeria.
| | | | | | | | | | - Kate U Edozieh
- Foundation for Charity and Community Health Nigeria, Abuja, Nigeria.
| | - Tolulope O Fagbemi
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria.
| | - Ahmad M Njidda
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria.
| | | | - Emmanuel C Agbo
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria.
| | - Nnamdi B Nwaneri
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria.
| | - Emmanuel D Shekarau
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria.
| | - Temitope O Obasa
- Department of Paediatrics and Child Health, College of Health Sciences, University of Ilorin, Ilorin, Kwara, Nigeria.
| | - Nnenna M Ezeigwe
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria.
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Febir LG, Baiden FE, Agula J, Delimini RK, Akpalu B, Tivura M, Amanfo N, Chandramohan D, Owusu-Agyei S, Webster J. Implementation of the integrated management of childhood illness with parasitological diagnosis of malaria in rural Ghana: health worker perceptions. Malar J 2015; 14:174. [PMID: 25899509 PMCID: PMC4430025 DOI: 10.1186/s12936-015-0699-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Timely and appropriate management of febrile illness among children under five years of age will contribute to achieving Millennium Development Goal-4. The revised World Health Organization-Global Malaria Programme's policy on test-based management of malaria must integrate effectively into the Integrated Management of Childhood Illness (IMCI). This study reports on perceptions of health workers on the health system factors influencing effective delivery of test-based diagnosis of malaria with IMCI. METHODS A qualitative study was conducted among a range of health workers at different levels of the health system in the Brong Ahafo Region of Ghana. Interview transcripts were transferred into Nvivo 8 software for data management and analysis. A frame-work approach at two levels was used in the analysis, which included the processes required for implementation of test-based management of malaria and the health systems context. RESULTS Forty-nine in-depth interviews were conducted. The National Health Insurance Scheme (NHIS) was perceived to have led to an increase in health facility attendance, thereby increasing the workload of health workers. Workload was reported as the main reason that health workers were not able to complete all of the examinations included in the IMCI algorithm. The NHIS financing guidelines were seen to be determining diagnosis and treatment practices by health-care givers. Concern was expressed about the erratic supply of malaria rapid diagnostic test kits (RDTs), the quality of RDTs related to potential false negative results when clinical symptoms were consistent with malaria. IMCI was seen as important but practically impossible to fully implement due to workload. CONCLUSIONS Implementation of the WHO-revised IMCI guideline is confronted with a myriad of health systems challenges. The perceptions of front-line health workers on the accuracy and need for RDTs together with the capacity of health systems to support implementation plays a crucial role. The NHIS financing guidelines of diagnostics and treatments are influencing clinical decision-making in this setting. Further study is needed to understand the impact of the NHIS on the feasibility of integrating test-based management for malaria into the IMCI guidelines.
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Affiliation(s)
| | - Frank E Baiden
- Epidemiology Unit, Ensign College of Public Health, Kpong, Eastern Region, Ghana.
| | - Justina Agula
- National Catholic Health Service, Project Fives Alive Christian Village KS 99, Kumasi, Ashanti Region, Ghana.
| | | | - Bright Akpalu
- University of Health and Allied Sciences, Ho, Ghana.
| | - Mathilda Tivura
- Kintampo Health Research Centre, PO Box 200, Kintampo, Ghana.
| | - Nelson Amanfo
- Kintampo Health Research Centre, PO Box 200, Kintampo, Ghana.
| | - Daniel Chandramohan
- Disease Control Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | | | - Jayne Webster
- Disease Control Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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