Use Of Rapid Diagnostic Test For Detecting Malaria Infection: Health Workers’ Perceptions And Adherence To Test Results At Health Facilities In The Agona East District Of The Central Region

ABSTRACT In 2010, World Health Organization came up with the policy of diagnostically testing for malaria among all age groups before treatment and Ghana has adopted this policy as part of the case management of Malaria. Presumptive diagnosis of malaria results in the abuse of anti-malaria drugs which may lead to the emergence of resistant strains of the parasite, wastage of antimalarials and misdiagnosis of malaria. Areas without microscopy, especially the peripheral areas are to use the rapid diagnostic test to diagnose malaria before treating. Studies have shown that under ideal conditions, results of RDT are comparable to that of microscopy. In spite of adopting this policy, studies show that clinicians do not adhere to results and continue to prescribe anti-malarials to those who test negative. This study sought to identify the proportion of malaria cases that was diagnosed presumptively compared to those that were tested at CHPS compounds and health centres in the Agona East district. It also aimed at identifying the perceptions and experiences with regards to testing before treatment using RDT among health workers in the District. The study involved a combination of quantitative and qualitative methods. Quantitative methods were used to assess adherence to negative test results and type of diagnosis used in six health facilities within the period of July to September 2015. This was achieved by analysing routine data on reports from three Community-based Health Planning and Service compounds and three health centres in the Agona East District. For the qualitative aspect, in-depth interviews were done with a purposive sample of 14 health personnel who treat and prescribe medication across health facilities within the district to explore their perceptions on the use of RDTs and identify any implementation challenges. Frequency tables were used to show proportions that got diagnosed with malaria, those that were presumptively diagnosed as well as treatment given to those who tested negative. Qualitative data was analysed thematically under three broad themes namely perception about rapid diagnostic test, adherence to negative test results and implementation challenges. Of the six health facilities in the Agona East District, 3.87% (14/362) were presumptively diagnosed with malaria whiles 96.10% (348/362) were diagnosed with malaria using RDT. v For those tested using the Rapid Diagnostic Test, 15.25% tested negative and 84.75% tested positive. Out of those who tested negative, anti-malarials were given to 20.75% and 79.25% received no anti-malarials. Health centres were much more likely to treat for malaria in cases where the results are negative compared to CHPS compounds. Health workers perceived the kit as easy to use and also as helping to make work easier. They used the kit mainly because the policy required them to do so. They however lacked confidence in negative test results, especially in cases where the person shows suspected signs and symptoms of malaria. However, this did not always influence their prescription practices. Shortages of RDT was the main reason why prescribers were presumptively diagnosing for malaria. There is a high testing rate in the district compared to the national testing rate. Health centres compared to CHPS compounds are likely to treat for malaria in cases where the results are negative. Health workers lack confidence in negative results and are likely to treat for malaria, refer the patient or just treat the underlying conditions if one tests negative. The major implementation challenge with regards to the RDT has to do with shortages.