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 OJEpi  Vol.9 No.4 , November 2019
Compliance with Malaria Rapid Diagnostic Test Results and Correlates among Clinicians in Uyo, Akwa Ibom State, Nigeria: 2018
Abstract: Introduction: In sub-Saharan Africa, 80% to 85% of RDT negative febrile patients, seen in outpatient clinics, were given anti-malarial medicines. Previous studies recommended investigating determinants of “compliance with RDT’ results” in specific cadre and setting, as intervention is most effective when context specific. Compliance with malaria RDT results and correlates among clinicians in Uyo was determined. Methods: A cross-sectional study of clinicians selected using stratified sampling. Data were collected using self-administered, semi-structured questionnaire on socio-demographics, facility audit of RDT supplies, knowledge, perception and practice of clinicians. Outcome variable of interest was whether or not clinicians self-reported compliance with RDT results. Exposure variables of interest were whether or not clinicians received RDT training; received supportive supervision for malaria RDT; had positive perception of RDT usefulness; had good knowledge of RDT use (scores of ≥75% in questions testing for knowledge); had readily available treatment guidelines; had diagnostic capacity for other common febrile illness; experienced patient overload; experienced stock-out of supplies; work in the private/public sector. Descriptive, bivariate and multivariate analyses were conducted. Results: Mean age of the clinicians was 33.0 years ± (6.0 SD). Of the total clinicians, 31.1% were female; 66.0% received RDT training; 36.4% had supportive supervision; 43.3% exhibited good knowledge of RDT use; 45.3% had positive perception of RDT usefulness and 41.7% relied on presumptive diagnosis. Compliances with RDT negative and positive results were 66.4% and 83.4% respectively. Compliance with RDT negative result was more in clinicians with good knowledge of RDT use (aOR = 25.0; 95% CI = 2.92 - 213.52). Compliance with RDT positive result was more in clinicians with good knowledge of RDT use (aOR = 10.0; 95% CI =2.70 - 18.72), positive perception of RDT usefulness (aOR = 10.2; 95%CI =3.50 - 29.63) and in health facilities in the public sector (aOR = 5.0; 95% CI = 2.00- 11.11). Training on RDT use was not significantly associated with compliance with RDT negative (aOR = 1.25; 95% CI = 0.63 - 2.44) nor positive result (aOR = 2.0; 95% CI = 0.63 - 5.00). Conclusions: Compliance was higher with RDT positive result; more in the public sector; and in clinicians with good knowledge of RDT use. Efforts to improve compliance should focus on RDT negative results; clinicians with poor knowledge of RDT use and negative perception of RDT usefulness; and those in the private sector. However further research involving explicit (analytic) study of compliance with RDT results is recommended.
Cite this paper: Effah, G. , Ekpenyong, B. , Babatunde, G. , Ajayi, I. and Dairo, D. (2019) Compliance with Malaria Rapid Diagnostic Test Results and Correlates among Clinicians in Uyo, Akwa Ibom State, Nigeria: 2018. Open Journal of Epidemiology, 9, 259-288. doi: 10.4236/ojepi.2019.94020.
References

[1]   WHO (2015) World Malaria Report 2015.

[2]   World Health Organization (2010) World Malaria Report. World Health [Internet]. WHO/HTM/GM(December), 238.
http://www.who.int/malaria/world_malaria_report_2011/9789241564403_eng.pdf

[3]   Boyce, M.R. and O’Meara, W.P. (2017) Use of Malaria RDTs in Various Health Contexts across Sub-Saharan Africa: A Systematic Review. BMC Public Health, 17, 470.
https://doi.org/10.1186/s12889-017-4398-1

[4]   Shillcutt, S., Morel, C., Goodman, C., Coleman, P., Bell, D., Whitty, C.J.M., et al. (2008) Cost-Effectiveness of Malaria Diagnostic Methods in Sub-Saharan Africa in an Era of Combination Therapy. Bulletin of the World Health Organization, 86, 101-110.
https://doi.org/10.2471/BLT.07.042259

[5]   Selimuzzaman, S.M., Islam, S.J., Nahar, Z., Das, R., Rahman, M.A. and Rahman, M.A. (2010) Malarigen Malaria Pf/Pv Antigen Rapid Test: A Simple and Effective Tool for Diagnosis of Malaria in the Far-Flung Hilly Areas of Bangladesh. Mymensingh Medical Journal, 19, 94-99.

[6]   Pulford, J., Smith, I., Mueller, I., Siba, P.M. and Hetzel, M.W. (2016) Health Worker Compliance with a “Test and Treat” Malaria Case Management Protocol in Papua New Guinea. PLoS ONE, 11, e0158780.
https://doi.org/10.1371/journal.pone.0158780

[7]   Pulford, J., Siba, P.M., Mueller, I. and Hetzel, M.W. (2014) The Exit Interview as a Proxy Measure of Malaria Case Management Practice: Sensitivity and Specificity Relative to Direct Observation. BMC Health Services Research, 14, 628.
https://doi.org/10.1186/s12913-014-0628-8

[8]   D’Acremont, V., Lengeler, C. and Genton, B. (2010) Reduction in the Proportion of Fevers Associated with Plasmodium falciparum Parasitaemia in Africa: A Systematic Review. Malaria Journal, 9, 240.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2936918&tool=
pmcentrez&rendertype=abstract
https://doi.org/10.1186/1475-2875-9-240


[9]   Bisoffi, Z., Tinto, H., Sirima, B.S., Gobbi, F., Angheben, A., Buonfrate, D., et al. (2013) Should Malaria Treatment Be Guided by a Point of Care Rapid Test? A Threshold Approach to Malaria Management in Rural Burkina Faso. PLoS ONE, 8, e58019.
https://doi.org/10.1371/journal.pone.0058019

[10]   Modrek, S., Schatzkin, E., De La Cruz, A., Isiguzo, C., Nwokolo, E., Anyanti, J., et al. (2014) SMS Messages Increase Adherence to Rapid Diagnostic Test Results among Malaria Patients: Results from a Pilot Study in Nigeria. Malaria Journal, 13, 69.
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84895930830&doi=10.1186%2F1475-2875-13-69&partnerID=40&md5=fcebf125dbdebaad3800811366386071

[11]   Uzochukwu, B.S.C., Onwujekwe, E., Ezuma, N.N., Ezeoke, O.P., Ajuba, M.O. and Sibeudu, F.T. (2011) Improving Rational Treatment of Malaria: Perceptions and Influence of RDTs on Prescribing Behaviour of Health Workers in Southeast Nigeria. PLoS ONE, 6, e14627.
https://doi.org/10.1371/journal.pone.0014627

[12]   Manyando, C., Njunju, E.M., Chileshe, J., Siziya, S. and Shiff, C. (2014) Rapid Diagnostic Tests for Malaria and Health Workers’ Adherence to Test Results at Health Facilities in Zambia. Malaria Journal, 13, 166.
http://www.ncbi.nlm.nih.gov/pubmed/24885996
https://doi.org/10.1186/1475-2875-13-166


[13]   Mokuolu, O.A., Ntadom, G.N., Ajumobi, O.O., Alero, R.A., Wammanda, R.D., Adedoyin, O.T., et al. (2016) Status of the Use and Compliance with Malaria Rapid Diagnostic Tests in Formal Private Health Facilities in Nigeria. Malaria Journal, 15, 4.
http://www.ncbi.nlm.nih.gov/pubmed/26728037
https://doi.org/10.1186/s12936-015-1064-x


[14]   Mubi, M., Kakoko, D., Ngasala, B., Premji, Z., Peterson, S., Björkman, A., et al. (2013) Malaria Diagnosis and Treatment Practices Following Introduction of Rapid Diagnostic Tests in Kibaha District, Coast Region, Tanzania. Malaria Journal, 12, Article No. 293.
http://malariajournal.biomedcentral.com/articles/10.1186/1475-2875-12-293
https://doi.org/10.1186/1475-2875-12-293


[15]   Hamer, D.H., Ndhlovu, M., Zurovac, D., Fox, M., Yeboah-Antwi, K., Chanda, P., et al. (2007) Improved Diagnostic Testing and Malaria Treatment Practices in Zambia. JAMA, 297, 2227-2231.
https://doi.org/10.1001/jama.297.20.2227

[16]   Kabaghe, A.N., Visser, B.J., Spijker, R., Phiri, K.S., Grobusch, M.P. and van Vugt, M. (2016) Health Workers’ Compliance to Rapid Diagnostic Tests (RDTs) to Guide Malaria Treatment: A Systematic Review and Meta-Analysis. Malaria Journal, 15, 163.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=
Citation&list_uids=26979286
https://doi.org/10.1186/s12936-016-1218-5


[17]   Grover-Kopec, E.K., Blumenthal, M.B., Ceccato, P., Dinku, T., Omumbo, J.A. and Connor, S.J. (2006) Web-Based Climate Information Resources for Malaria Control in Africa. Malaria Journal, 5, Article No. 38.
http://malariajournal.biomedcentral.com/articles/10.1186/1475-2875-5-38
https://doi.org/10.1186/1475-2875-5-38


[18]   Charan, J. and Biswas, T. (2013) How to Calculate Sample Size for Different Study Designs in Medical Research? Indian Journal of Psychological Medicine, 35, 121-126.
http://www.ijpm.info/text.asp?2013/35/2/121/116232
https://doi.org/10.4103/0253-7176.116232


[19]   Chanda, P., Hamainza, B., Moonga, H.B., Chalwe, V. and Pagnoni, F. (2011) Community Case Management of Malaria Using ACT and RDT in Two Districts in Zambia: Achieving High Adherence to Test Results Using Community Health Workers. Malaria Journal, 10, Article No. 158.
http://malariajournal.biomedcentral.com/articles/10.1186/1475-2875-10-158
https://doi.org/10.1186/1475-2875-10-158


[20]   Burchett, H.E.D., Leurent, B., Baiden, F., Baltzell, K., Björkman, A., Bruxvoort, K., et al. (2017) Improving Prescribing Practices with Rapid Diagnostic Tests (RDTs), Synthesis of 10 Studies to Explore Reasons for Variation in Malaria RDT Uptake and Adherence. BMJ Open, 7, e012973.
https://doi.org/10.1136/bmjopen-2016-012973

[21]   Chanda, P., Hamainza, B., Moonga, H.B., Chalwe, V. and Pagnoni, F. (2011) Community Case Management of Malaria Using ACT and RDT in Two Districts in Zambia: Achieving High Adherence to Test Results Using Community Health Workers. Malaria Journal, 10, 158.
https://doi.org/10.1186/1475-2875-10-158

[22]   Bamiselu, O.F., Ajayi, I., Fawole, O., Dairo, D., Ajumobi, O., Oladimeji, A., et al. (2016) Adherence to Malaria Diagnosis and Treatment Guidelines among Healthcare Workers in Ogun State, Nigeria. BMC Public Health, 16, Article No. 828.
http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3495-x
https://doi.org/10.1186/s12889-016-3495-x


[23]   Mbacham, W.F., Mangham-Jefferies, L., Cundill, B., Achonduh, O.A., Chandler, C.I.R., Ambebila, J.N., et al. (2014) Basic or Enhanced Clinician Training to Improve Adherence to Malaria Treatment Guidelines: A Cluster-Randomised Trial in Two Areas of Cameroon. The Lancet Global Health, 2, e346-e358.
https://doi.org/10.1016/S2214-109X(14)70201-3

[24]   Cundill, B., Mbakilwa, H., Chandler, C.I.R., Mtove, G., Mtei, F., Willetts, A., et al. (2015) Prescriber and Patient-Oriented Behavioural Interventions to Improve Use of Malaria Rapid Diagnostic Tests in Tanzania: Facility-Based Cluster Randomised Trial. BMC Medicine, 13, 118.
https://doi.org/10.1186/s12916-015-0346-z

[25]   Bisoffi, Z., Sirima, B.S., Angheben, A., Lodesani, C., Gobbi, F., Tinto, H., et al. (2009) Rapid Malaria Diagnostic Tests vs. Clinical Management of Malaria in Rural Burkina Faso: Safety and Effect on Clinical Decisions. A Randomized Trial. Tropical Medicine & International Health, 14, 491-498.
https://doi.org/10.1111/j.1365-3156.2009.02246.x

[26]   Kyabayinze, D.J., Asiimwe, C., Nakanjako, D., Nabakooza, J., Bajabaite, M., Strachan, C., et al. (2012) Programme Level Implementation of Malaria Rapid Diagnostic Tests (RDTs) Use: Outcomes and Cost of Training Health Workers at Lower Level Health Care Facilities in Uganda. BMC Public Health, 12, 291.
https://doi.org/10.1186/1471-2458-12-291

[27]   McMorrow, M.L., Aidoo, M. and Kachur, S.P. (2011) Malaria Rapid Diagnostic Tests in Elimination Settings—Can They Find the Last Parasite? Clinical Microbiology and Infection, 17, 1624-1631.
https://doi.org/10.1111/j.1469-0691.2011.03639.x

[28]   Davis, K.M., Gibson, L.E., Haselton, F.R. and Wright, D.W. (2014) Simple Sample Processing Enhances Malaria Rapid Diagnostic Test Performance. Analyst, 139, 3026-3031.
http://pubs.rsc.org/en/content/articlehtml/2014/an/c4an00338a
https://doi.org/10.1039/C4AN00338A


[29]   Selemani, M., Masanja, I.M., Kajungu, D., Amuri, M., Njozi, M. and Khatib, R.A. (2013) Health Worker Factors Associated with Prescribing of Artemisinin Combination Therapy for Uncomplicated Malaria in Rural Tanzania. Malaria Journal, 12, 334.
https://doi.org/10.1186/1475-2875-12-334

[30]   Bottieau, E. (2013) Point-of-Care Testing: Filling the Diagnostic Gaps in Tropical Medicine? Clinical Microbiology and Infection, 19, 397-398.
https://doi.org/10.1111/1469-0691.12200

[31]   Chinkhumba, J., Skarbinski, J., Chilima, B., Campbell, C., Ewing, V., San Joaquin, M., et al. (2010) Comparative Field Performance and Adherence to Test Results of Four Malaria Rapid Diagnostic Tests among Febrile Patients More than Five Years of Age in Blantyre, Malawi. Malaria Journal, 9, 209.
https://doi.org/10.1186/1475-2875-9-209

[32]   Shakely, D., Elfving, K., Aydin-Schmidt, B., Msellem, M.I., Morris, U., Omar, R., et al. (2013) The Usefulness of Rapid Diagnostic Tests in the New Context of Low Malaria Transmission in Zanzibar. PLoS ONE, 8, e72912.
http://dx.plos.org/10.1371/journal.pone.0072912
https://doi.org/10.1371/journal.pone.0072912


 
 
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