FACTORS INFLUENCING THE UTILISATION OF RAPID DIAGNOSTIC TESTS IN DIAGNOSIS OF MALARIA BY HEALTHCARE PROVIDERS, ALIMOSHO LGA, LAGOS STATE, NIGERIA

Abstract

Prompt and accurate diagnosis is crucial for effective management of malaria cases and case management still remains a vital component of the malaria elimination strategies. The new national treatment guidelines were initiated to improve case management and reduce morbidity and mortality due to malaria in the country. However, success depends on health workers compliance to the treatment guidelines. This study therefore seeks to document the gaps in knowledge with respect to diagnosis of malaria, availability and utilization of Rapid Diagnostics Tests (RDTs) by health workers in health facilities. This study identified the factors influencing the utilization of Rapid Diagnostic Tests by health workers for the diagnosis of Malaria in health facilities in Alimosho Local Government Area (LGA), Lagos, Nigeria. This study was a descriptive cross-sectional survey carried out between March and April, 2016. The respondents were selected using a multistage sampling technique, hence 89 health facilities from the 36 wards of the LGA were included in the study. A four hundred and twenty (420) pretested structured interviewer administered questionnaires were used to collect information on socio-demographic, awareness, knowledge, perception and factors influencing the availability and utilization of RDTs in health facilities. Data analysis was done using Epi info version 7. Univariate analysis was done by frequencies and percentages while association between the dependent variable: utilization of RDTs and independent variables: age, sex, years of practice. occupation and level of education were tested using Prevalence odds ratio. Multivariate analysis using binary logistic regression was done to determine the predictors of utilization of RDTs with level of significance set at P value <0.05. Majority of the healthcare providers interviewed were female (83.3%). The mean age of respondents was 35.9 years (S.D ± 8.76). RDTs were readily available (77.1%) and utilized (65.1%%) in health facility. Presumptive diagnosis of malaria (94.7%) was the preferred method of diagnosis in all facility type. The main reasons for non-utilization of RDT were unreliability of RDTs test results (34.76%), supply related issues (34.52%), cost of RDTs (12.86%) and preference for other methods (8.8%). Factors influencing utilization of RDTs among healthcare providers were: type of health facility (aOR= 6.53, 95%CI= 1.18-36.21. P=0.03), Supervisory visits to health worker from higher levels (aOR= 10.52. 95 %CI=l.77-62.48, P=0.0 I) and availability of RDTs test kits at health facility (aOR= 18.90, 95%Cl= 23.97-80.25, P<0.01) Use of RDTs was low despite its availability at health facilities. Most health workers still used the presumptive diagnosis method in management of malaria cases. Perceived unreliability, supply related issues and cost remained limiting factors to the use of RDTs. Interventions such as sensitization of healthcare providers on the national treatment guidelines on RDTs, provision of RDTs at subsidized rate and supportive supervision of healthcare providers is recommended. In addition, training and re-training of healthcare providers is suggested to improve malaria case management in the State.