Abstract:
Background:
The success of the universal parasite-based malaria testing policy for fever patients attending primary
health care (PHC) facilities in Tanzania will depend highly on health workers
’
perceptions and practices. The aim of
this study was, therefore, to assess the present use of malaria diagnostics (rapid diagnostic tests (RDTs) and
microscopy), prescription behaviour and factors affecting adherence to test results at PHC facilities in Kibaha District,
Coast Region, Tanzania.
Methods:
Exit interviews were conducted with fever patients at PHC facilities and information on diagnostic test
performed and treatment prescribed were recorded. Interviews with prescribers to assess their understanding,
perceptions and practices related to RDTs were conducted, and health facility inventory performed to assess
availability of staff, diagnostics and anti-malarial drugs.
Results:
The survey was undertaken at ten governmental PHC facilities, eight of which had functional diagnostics.
Twenty health workers were interviewed and 195 exit interviews were conducted with patients at the PHC facilities.
Of the 168 patients seen at facilities with available diagnostics, 105 (63%) were tested for malaria, 31 (30%) of
whom tested positive. Anti-malarial drugs were prescribed to all patients with positive test results, 14% of patients
with negative results and 28% of patients not tested for malaria. Antibiotics were more likely to be prescribed to
patients with negative test results compared to patients with positive results (81
vs
39%, p < 0.01) and among non-
tested compared to those tested for malaria (84
vs
69%, p = 0.01). Stock-outs of RDTs and staff shortage accounted
for the low testing rate, and health worker perceptions were the main reason for non-adherence to test results.
Conclusions:
Anti-malarial prescription to patients with negative test results and those not tested is still practiced
in Tanzania despite the universal malaria testing policy of fever patients. The use of malaria diagnostics was also
associated with higher prescription of antibiotics among patients with negative results. Strategies to address health
system factors and health worker perceptions associated with these practices are needed.
