Improving rational treatment of malaria: perceptions and influence of RDTs on prescribing behaviour of health workers in southeast Nigeria

• Published in: PloS one Vol. 6; no. 1; p. e14627
• Main Authors: Uzochukwu, Benjamin S C, Onwujekwe, Emmanuel, Ezuma, Nkoli N, Ezeoke, Ogochukwu P, Ajuba, Miriam O, Sibeudu, Florence T
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 31.01.2011; Public Library of Science (PLoS)
• Subjects: Analysis; Antimalarials; Antimalarials - therapeutic use; Artemisinin; Artemisinins - therapeutic use; Behavior; Care and treatment; Chloroquine; College campuses; Community Health Workers - standards; Diagnosis; Diagnostic systems; Diagnostic tests; Diagnostic Tests, Routine - methods; Diagnostic Tests, Routine - statistics & numerical data; Drugs; Health care policy; Hospital administration; Human error; Humans; Infectious Diseases/Protozoal Infections; Laboratories; Local government; Malaria; Malaria - drug therapy; Medical diagnosis; Medical personnel; Microscopy; Nigeria; Patient admissions; Practice Patterns, Physicians' - standards; Practice Patterns, Physicians' - statistics & numerical data; Prescription writing; Primary care; Public health; Public Health and Epidemiology/Health Services Research and Economics; Public Health and Epidemiology/Infectious Diseases; Quality control; Reagent Kits, Diagnostic; User fees; Vector-borne diseases; Workers; Nigeria; Africa; Nigeria, Enugu
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0014627

Developments in rapid diagnostic tests (RDTs) have opened new possibilities for improved remote malaria diagnosis that is independent of microscopic diagnosis. Studies in some settings have tried to assess the influence of RDTs on the prescribing behaviour of health workers, but such information is generally lacking in Nigeria and many parts of sub-Saharan Africa. This study analysed health workers' perceptions of RDTs and their potential influence on their prescribing and treatment practices after their introduction. The study was conducted in four health centers in the Enugu East local government of Enugu State, Nigeria. All 32 health workers in the health centers where RDTs were deployed were interviewed by field workers. Information was sought on their perception of symptoms-based, RDT-based, and microscopy-based malaria diagnoses. In addition, prescription analysis was carried out on 400 prescriptions before and 12 months after RDT deployment. The majority of the health workers perceived RDTs to be more effective for malaria diagnosis than microscopy and clinical diagnosis. They also felt that the benefits of RDTs included increased use of RDTs in the facilities and the tendency to prescribe more Artemisinin-based combination therapies (ACTs) and less chloroquine and SP. Some of the health workers experienced some difficulties in the process of using RDT kits. ACTs were prescribed in 74% of RDT-negative results. RDT-supported malaria diagnosis may have led to the overprescription of ACTs, with the drug being prescribed to people with RDT-negative results. However, the prescription of other antimalarial drugs that are not first-line drugs has been reduced. Efforts should be made to encourage health workers to trust RDT results and prescribe ACTs only to those with positive RDT results. In-depth studies are needed to determine why health workers continue to prescribe ACTs in RDT-negative results.