The authors declare that they have no competing interests.
CC, NE, OO, VW, LMJ & BU designed the study. NE, OE & LMJ were involved in data collection. NE & OE undertook data analysis; OE drafted the manuscript with assistance from all authors. OO, VW and BU provided guidance throughout the entire process. All authors read and approved the final manuscript.
The adoption of ACT as the first line treatment for uncomplicated malaria in Nigeria has concentrated attention on the role of testing in appropriate malaria treatment. There are calls at both national and global level for malaria treatment to be based on test result, but it is still unclear how testing can be incorporated into treatment-seeking and practices of health providers. This study explored community members and health providers’ perceptions and experiences with malaria tests in south east Nigeria.
The study was conducted in urban and rural areas of Enugu state in south-eastern Nigeria. A total of 18 focus group discussions with 179 community members including sub-groups of primary caregivers, adult men and adult women aged 15 years and above. Twenty- six (26) In-depth interviews were held with public and private health providers involved in prescribing medicines at public and private health facilities in the study area.
Both providers and community members were familiar with malaria tests and identified malaria tests as an important step to distinguish malaria from other illnesses with similar symptoms and as a means of delivering appropriate treatment. However, the logic of test-directed treatment was undermined by cost of test and a lack of testing facilities but above all concerns over the reliability of negative test results, with community members and providers observing inconsistencies between results and symptoms, and providers attributing inaccurate results to incompetencies of technicians. Recognition of malaria symptoms was deemed most important in determining the use of antimalarial drugs rather than the result of a malaria test.
The results highlight important areas of intervention to promote appropriate malaria treatment. If tests are to play a role in patient management, demand and supply side interventions are needed to change people’s attitude towards malaria test results.
Federal Republic of Nigeria: National antimalarial treatment policy Abuja. 2005, Nigeria: FMOH
World Health Organization: Second edition. Guidelines for treatment of malaria. 2010, Switzerland: WHO, Geneva
World Health Organization: An operational manual. Universal access to malaria diagnostic testing. 2011, http://www.who.int/malaria/publications/atoz/9789241502092/en/index.html,
National Population Commission (NPC) [Nigeria]: National malaria control programme (NMCP) [Nigeria], and ICF international: Nigeria malaria indicator survey 2010. NPC, NMCP. 2012, Abuja, Nigeria: ICF International
Uzochukwu B, Chiegboka L, Enweruzo C, Nwosu U, Okorafor D, Onwujekwe O, Uguru N, Sibeudu F, Ezeoke O: Examining appropriate diagnosis and treatment of malaria: availability and use of rapid diagnostic tests and artemisinin-based combination therapy in public and private health facilities in south east Nigeria. BMC Publ Health. 2010, 10: 48-10.1186/1471-2458-10-48. CrossRef
Chandler C, Mangham L, Njei A, Achonduh O, Mbacham W, Wiseman V: ‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests. Soc Sci Med. 2012, 74: 1528-1535. 10.1016/j.socscimed.2012.01.025. CrossRefPubMed
Mukanga D, Tibenderana JK, Kiguli J, Pariyo GW, Waiswa P, Bajunirwe F, Mutamba B, Counihan H, Ojiambo G, Kallander K: Community acceptability of use of rapid diagnostic tests for malaria by community health workers in Uganda. Malar J. 2009, 9: 203- CrossRef
Nigeria Population Commission (NPC): National census figures. 2006, Abuja: Nigeria Population Commission
McMorrow M, Masanja M, Kahigwa E, Abdulla S, Kachur P: Quality assurance of rapid diagnostic tests for malaria in routine patient care in rural Tanzania. AmJTrop Med Hyg. 2010, 82: 151-155. 10.4269/ajtmh.2010.09-0440. CrossRef
Ishengoma D, Francis F, Mmbando B, Lusingu J, Magistrado P, Alifrangis M, Theander T, Bygbjerg I, Lemge M: Accuracy of rapid diagnostic tests in community studies and their impact on treatment of malaria in an area with declining malaria burden in north-eastern Tanzania. Malar J. 2011, 10: 176-10.1186/1475-2875-10-176. PubMedCentralCrossRefPubMed
Sserwanga A, Harris JC, Kigozi R, Menon M, Bukirwa H, Gasasira A, Kakeeto S, Kizito F, Quinto E, Rubahika D, Nasr S, Filler S, Kamya M, Dorsey G: Improved malaria case management through the implementation of a health facility-based sentinel site surveillance system in Uganda. PLoS One. 2011, 6: e16316-10.1371/journal.pone.0016316. PubMedCentralCrossRefPubMed
Polage C, Bedu-Addo G, Owusu-Ofori A, Frimpong E, Lloyd W, Zurcher E, Hale D, Petti C: Laboratory use in Ghana: Physician perception and practice. AmJTrop Med Hyg. 2006, 3: 526-531.
- Exploring health providers’ and community perceptions and experiences with malaria tests in South-East Nigeria: a critical step towards appropriate treatment
Ogochukwu P Ezeoke
Nkoli N Ezumah
Clare CI Chandler
Lindsay J Mangham-Jefferies
Obinna E Onwujekwe
Benjamin S Uzochukwu
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II