DETERMINANTS OF MANAGEMENT PRACTICES FOR MALARIA RAPID DIAGNOSTIC TEST NEGATIVE PATIENTS AMONG HEALTH CARE WORKERS IN OYO STATE

Abstract

The availability of quality assured malaria rapid diagnostic test has increased the opportunity for parasitological diagnosis of malaria even where microscopy is not available. It is on the basis of this, and the declining incidence of malaria that the World Health Organization recommends that antimalarial medicines should be offered only to patients who have positive parasitology test result for malaria and this was adopted by the Federal Ministry of Health. Health workers however continue to prescribe antimalarial medicine to patients with negative RDT result. The reasons why they do so is not clearly understood. This study was carried out to identify the practices of health workers in Oyo State in managing patients with negative RDT results and the factors associated with such practices. A cross sectional study was carried out from June to August 2016. Participants were selected by multistage sampling technique. Two thirds (22) of the 33 Local Government Areas (LGAs) in the state were selected. From the list of the 497 health facilities that received routine supply of RDT kits in the selected LGAs, one third (166) were selected. Four Hundred and Twenty-three health workers were calculated to be required for the study. The sample size was proportionately allocated to the selected health facilities. Eligible health workers were selected from each facility using simple random sampling method. Trained research assistants interviewed the selected health workers using pretested, semi-structured questionnaires. Data were collected on socio-demographics, training and supervision experience, fever case management, and availability of laboratory support. Data were analysed using descriptive statistics, Chi square and logistic regression model at 5% level of significance. Mean age of respondents was 41 years (± 9 years). Among them, 248/423 (58.7%) were Community Health Workers and 322/423 (71.6%) were females. When a patient's RDT result is negative, 362/423 (85.6%) refer the patient for further laboratory investigations while 110/423 (24.1 %) prescribe antimalarial medicine to them. Prescription of antimalarial medicine to RDT negative patients was higher among those who were not trained on case management of malaria (51.1 %) compared to those who were trained (17.0%) (X2= 44.34; P< 0.001); higher among those who were not trained on RDT use (53.2%) compared to those who were trained (15.8%) (X2= 55.84; P< 0.001); higher among those working in private facilities (34.3%) compared with those working in public facilities (20.8%) (X2= 11.66; P = 0.005), and higher among those working in urban facilities (30.5%) compared with those working in rural facilities (16.8%) (X2= 10.92; P<0.001). On logistic regression, Lack of training on RDT use (AOR = 3.20; 95% CI [1.58 - 6.50]) and lack of training on case management of malaria (AOR = 2.22; 95% CI [1. 10 - 4.48]) remained significantly associated with prescription of antimalarial medicine to RDT negative patients. Lack of training was a major factor influencing prescription of antimalarial medicine to RDT negative patients. It is therefore recommended that health workers should be adequately trained to prevent adverse consequences of wrong antimalarial prescriptions.