Factors associated with Malaria rapid diadnostic test use and adherence to test results by health care workers in Iringa rural district

Abstract

Background: ew guidelines on malaria case management include confirmation of malaria episode using mRDT (WHO malaria report 2009). Thus mRDTs are being deployed in most endemic countries in sub-Saharan Africa including Tanzania. Use of mRDTs by HCWs and adherence to test results is thus important in order to reduce the over use of highly effective but expensive ACTs. This may lead to improved targeting of antimalarials, improved health outcome and increased patient satisfaction. Use of mRDTs and adherence to test negative results by HCWs has shown a mixture of results in recent studies leading to inconsistent use and non adherence thus increasing over prescription of antirnalarials among other things. Most studies suggests that the main factor of non use and adherence to test results for HCWs is the ambiguity nature of the guidelines, training messages which have been insisting that any fever means malaria and some senses of mistrust on the accuracy of m R DTs. Methods: Thirty dispensaries were randomly selected to evaluate the pilot program conducted by NMCP. All HCWs found in these dispensaries were interviewed and assessment of whether they use and adhere to test results was done through review of registers. The first outcome variable was the proportion of HCWs who used mRDTs and the second outcome variable was the proportion of HCWs who adhere to test results. The chi-square statistic was used to determine association between independent variables and outcome variables. Results: A total of 70 HCWs were interviewed to determine their knowledge on mRDT. Of these 18 were not assessed for use of mRDT as they had never prescribed. 52 prescribers were assed for use and adherence to test results. Only 39 (75%) were using mRDT and 13 (25%) never used mRDT. one of the factors was significantly associated with use ofmRDT by HCWs. Conclusion: The lesson learnt form the pilot which was done in Iringa rural was not sufficient to warrant national roll out of mRDTs. Improved supportive supervision, well defined logistics for ordering mRDTs, feed back to HCWs on what they are doing and training packages that in cooperate theories for behaviour change could increase the proportion of HCWs who use and adhere to test results.