‘Presumptive treatment of uncomplicated malaria remains an ingrained behaviour that is difficult to change’, say the authors of a new study from Nigeria. In the conclusion of the full text, they say: ‘Given the challenges we have outlined, it will be particularly important to consider whether it is cost-effective for the government to support the roll-out of RDTs in the private sector and we would recommend further investigation of this issue.’
This is an interesting point: Whether to abandon RDTs (rapid diagnostic tests) on the basis that it is too difficult to persuade healthcare providers to use them appropriately, or to continue to seek better ways to encourage such use. Are HIFA members aware of examples of successful introduction of RDTs in Nigeria or other malaria-endemic countries?
CITATION: Effectiveness of Provider & Community Interventions to Improve Treatment of Uncomplicated #Malaria, Nigeria
Obinna Onwujekwe, Lindsay Mangham-Jefferies, Bonnie Cundill, Neal Alexander, Julia Langham, Ogochukwu Ibe, Benjamin Uzochukwu, Virginia Wiseman
Published: August 26, 2015DOI: 10.1371/journal.pone.0133832
The World Health Organization recommends that malaria be confirmed by parasitological diagnosis before treatment using Artemisinin-based Combination Therapy (ACT). Despite this, many health workers in malaria endemic countries continue to diagnose malaria based on symptoms alone. This study evaluates interventions to help bridge this gap between guidelines and provider practice. A stratified cluster-randomized trial in 42 communities in Enugu state compared 3 scenarios: Rapid Diagnostic Tests (RDTs) with basic instruction (control); RDTs with provider training (provider arm); and RDTs with provider training plus a school-based community intervention (provider-school arm). The primary outcome was the proportion of patients treated according to guidelines, a composite indicator requiring patients to be tested for malaria and given treatment consistent with the test result. The primary outcome was evaluated among 4946 (93%) of the 5311 patients invited to participate. A total of 40 communities (12 in control, 14 per intervention arm) were included in the analysis. There was no evidence of differences between the three arms in terms of our composite indicator (p = 0.36): stratified risk difference was 14% (95% CI -8.3%, 35.8%; p = 0.26) in the provider arm and 1% (95% CI -21.1%, 22.9%; p = 0.19) in the provider-school arm, compared with control. The level of testing was low across all arms (34% in control; 48% provider arm; 37% provider-school arm; p = 0.47). Presumptive treatment of uncomplicated malaria remains an ingrained behaviour that is difficult to change. With or without extensive supporting interventions, levels of testing in this study remained critically low. Governments and researchers must continue to explore alternative ways of encouraging providers to deliver appropriate treatment and avoid the misuse of valuable medicines.
Best wishes, Neil
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