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Published in: Malaria Journal 1/2012

Open Access 01-12-2012 | Research

Exploring health providers’ and community perceptions and experiences with malaria tests in South-East Nigeria: a critical step towards appropriate treatment

Authors: Ogochukwu P Ezeoke, Nkoli N Ezumah, Clare CI Chandler, Lindsay J Mangham-Jefferies, Obinna E Onwujekwe, Virginia Wiseman, Benjamin S Uzochukwu

Published in: Malaria Journal | Issue 1/2012

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Abstract

Background

The adoption of ACT as the first line treatment for uncomplicated malaria in Nigeria has concentrated attention on the role of testing in appropriate malaria treatment. There are calls at both national and global level for malaria treatment to be based on test result, but it is still unclear how testing can be incorporated into treatment-seeking and practices of health providers. This study explored community members and health providers’ perceptions and experiences with malaria tests in south east Nigeria.

Methods

The study was conducted in urban and rural areas of Enugu state in south-eastern Nigeria. A total of 18 focus group discussions with 179 community members including sub-groups of primary caregivers, adult men and adult women aged 15 years and above. Twenty- six (26) In-depth interviews were held with public and private health providers involved in prescribing medicines at public and private health facilities in the study area.

Results

Both providers and community members were familiar with malaria tests and identified malaria tests as an important step to distinguish malaria from other illnesses with similar symptoms and as a means of delivering appropriate treatment. However, the logic of test-directed treatment was undermined by cost of test and a lack of testing facilities but above all concerns over the reliability of negative test results, with community members and providers observing inconsistencies between results and symptoms, and providers attributing inaccurate results to incompetencies of technicians. Recognition of malaria symptoms was deemed most important in determining the use of antimalarial drugs rather than the result of a malaria test.

Conclusion

The results highlight important areas of intervention to promote appropriate malaria treatment. If tests are to play a role in patient management, demand and supply side interventions are needed to change people’s attitude towards malaria test results.
Literature
1.
go back to reference Federal Republic of Nigeria: National antimalarial treatment policy Abuja. 2005, Nigeria: FMOH Federal Republic of Nigeria: National antimalarial treatment policy Abuja. 2005, Nigeria: FMOH
2.
go back to reference World Health Organization: Second edition. Guidelines for treatment of malaria. 2010, Switzerland: WHO, Geneva World Health Organization: Second edition. Guidelines for treatment of malaria. 2010, Switzerland: WHO, Geneva
4.
go back to reference National Population Commission (NPC) [Nigeria]: National malaria control programme (NMCP) [Nigeria], and ICF international: Nigeria malaria indicator survey 2010. NPC, NMCP. 2012, Abuja, Nigeria: ICF International National Population Commission (NPC) [Nigeria]: National malaria control programme (NMCP) [Nigeria], and ICF international: Nigeria malaria indicator survey 2010. NPC, NMCP. 2012, Abuja, Nigeria: ICF International
5.
go back to reference Petti C, Polage C, Quinn T, Ronald A, Sande M: Laboratory medicine in Africa: A Barrier to effective healthcare. Clin Infect Dis. 2006, 42: 377-382. 10.1086/499363.CrossRefPubMed Petti C, Polage C, Quinn T, Ronald A, Sande M: Laboratory medicine in Africa: A Barrier to effective healthcare. Clin Infect Dis. 2006, 42: 377-382. 10.1086/499363.CrossRefPubMed
6.
go back to reference Derua Y, Ishengoma D, Rwegoshora R, Tenu F, Massaga J, Mboera L, Magesa S: User’s and health service provider’s perception on quality of laboratory malaria diagnosis in Tanzania. Malar J. 2011, 10: 78-10.1186/1475-2875-10-78.PubMedCentralCrossRefPubMed Derua Y, Ishengoma D, Rwegoshora R, Tenu F, Massaga J, Mboera L, Magesa S: User’s and health service provider’s perception on quality of laboratory malaria diagnosis in Tanzania. Malar J. 2011, 10: 78-10.1186/1475-2875-10-78.PubMedCentralCrossRefPubMed
7.
go back to reference Uzochukwu B, Chiegboka L, Enweruzo C, Nwosu U, Okorafor D, Onwujekwe O, Uguru N, Sibeudu F, Ezeoke O: Examining appropriate diagnosis and treatment of malaria: availability and use of rapid diagnostic tests and artemisinin-based combination therapy in public and private health facilities in south east Nigeria. BMC Publ Health. 2010, 10: 48-10.1186/1471-2458-10-48.CrossRef Uzochukwu B, Chiegboka L, Enweruzo C, Nwosu U, Okorafor D, Onwujekwe O, Uguru N, Sibeudu F, Ezeoke O: Examining appropriate diagnosis and treatment of malaria: availability and use of rapid diagnostic tests and artemisinin-based combination therapy in public and private health facilities in south east Nigeria. BMC Publ Health. 2010, 10: 48-10.1186/1471-2458-10-48.CrossRef
8.
go back to reference Reyburn H, Mbakilwa H, Mwangi R, Mwerinde O, Olomi R, Drakeley C, Whitty C: Rapid diagnostic tests compared with malaria microscopy for guiding outpatient treatment of febrile illness in Tanzania: randomised trial. BMJ. 2007, 334: 403-10.1136/bmj.39073.496829.AE.PubMedCentralCrossRefPubMed Reyburn H, Mbakilwa H, Mwangi R, Mwerinde O, Olomi R, Drakeley C, Whitty C: Rapid diagnostic tests compared with malaria microscopy for guiding outpatient treatment of febrile illness in Tanzania: randomised trial. BMJ. 2007, 334: 403-10.1136/bmj.39073.496829.AE.PubMedCentralCrossRefPubMed
9.
go back to reference Mangham L, Cundill B, Ezeoke O, Nwala E, Uzochukwu BSC, Wiseman V, Onwujekwe O: Treatment of uncomplicated malaria at public health facilities and medicine retailers in south-eastern Nigeria. Malar J. 2011, 10: 155-10.1186/1475-2875-10-155.PubMedCentralCrossRefPubMed Mangham L, Cundill B, Ezeoke O, Nwala E, Uzochukwu BSC, Wiseman V, Onwujekwe O: Treatment of uncomplicated malaria at public health facilities and medicine retailers in south-eastern Nigeria. Malar J. 2011, 10: 155-10.1186/1475-2875-10-155.PubMedCentralCrossRefPubMed
10.
go back to reference Chandler C, Whitty C, Ansah K: How can malaria rapid diagnostic tests achieve their potential? A qualitative study of a trial at health facilities in Ghana. Malar J. 2010, 9: 95-10.1186/1475-2875-9-95.PubMedCentralCrossRefPubMed Chandler C, Whitty C, Ansah K: How can malaria rapid diagnostic tests achieve their potential? A qualitative study of a trial at health facilities in Ghana. Malar J. 2010, 9: 95-10.1186/1475-2875-9-95.PubMedCentralCrossRefPubMed
11.
go back to reference Chandler C, Mangham L, Njei A, Achonduh O, Mbacham W, Wiseman V: ‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests. Soc Sci Med. 2012, 74: 1528-1535. 10.1016/j.socscimed.2012.01.025.CrossRefPubMed Chandler C, Mangham L, Njei A, Achonduh O, Mbacham W, Wiseman V: ‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests. Soc Sci Med. 2012, 74: 1528-1535. 10.1016/j.socscimed.2012.01.025.CrossRefPubMed
12.
go back to reference Fairhead J, Leach M, Small M: Where techno-science meets poverty: Medical research and the economy of blood in the Gambia, West Africa. Soc Sci Med. 2006, 63: 1109-1120. 10.1016/j.socscimed.2006.02.018.CrossRefPubMed Fairhead J, Leach M, Small M: Where techno-science meets poverty: Medical research and the economy of blood in the Gambia, West Africa. Soc Sci Med. 2006, 63: 1109-1120. 10.1016/j.socscimed.2006.02.018.CrossRefPubMed
13.
go back to reference Newton S, Doku V, Geissler W, Asante K, Cousens S: Drawing blood from young children: lessons learned from a trial in Ghana. Trans R Soc Trop Med Hyg. 2009, 103: 497-499. 10.1016/j.trstmh.2008.11.030.CrossRefPubMed Newton S, Doku V, Geissler W, Asante K, Cousens S: Drawing blood from young children: lessons learned from a trial in Ghana. Trans R Soc Trop Med Hyg. 2009, 103: 497-499. 10.1016/j.trstmh.2008.11.030.CrossRefPubMed
14.
go back to reference Mukanga D, Tibenderana JK, Kiguli J, Pariyo GW, Waiswa P, Bajunirwe F, Mutamba B, Counihan H, Ojiambo G, Kallander K: Community acceptability of use of rapid diagnostic tests for malaria by community health workers in Uganda. Malar J. 2009, 9: 203-CrossRef Mukanga D, Tibenderana JK, Kiguli J, Pariyo GW, Waiswa P, Bajunirwe F, Mutamba B, Counihan H, Ojiambo G, Kallander K: Community acceptability of use of rapid diagnostic tests for malaria by community health workers in Uganda. Malar J. 2009, 9: 203-CrossRef
15.
go back to reference Berwick D: Disseminating innovations in health care. JAMA. 2003, 289: 1969-1975. 10.1001/jama.289.15.1969.CrossRefPubMed Berwick D: Disseminating innovations in health care. JAMA. 2003, 289: 1969-1975. 10.1001/jama.289.15.1969.CrossRefPubMed
16.
go back to reference Nigeria Population Commission (NPC): National census figures. 2006, Abuja: Nigeria Population Commission Nigeria Population Commission (NPC): National census figures. 2006, Abuja: Nigeria Population Commission
17.
go back to reference Okeke TA, Okeibunor JC: Rural–urban differences in health-seeking for the treatment of childhood malaria in south-east Nigeria. Health Policy. 2010, 95: 62-68. 10.1016/j.healthpol.2009.11.005.CrossRefPubMed Okeke TA, Okeibunor JC: Rural–urban differences in health-seeking for the treatment of childhood malaria in south-east Nigeria. Health Policy. 2010, 95: 62-68. 10.1016/j.healthpol.2009.11.005.CrossRefPubMed
18.
go back to reference McMorrow M, Masanja M, Kahigwa E, Abdulla S, Kachur P: Quality assurance of rapid diagnostic tests for malaria in routine patient care in rural Tanzania. AmJTrop Med Hyg. 2010, 82: 151-155. 10.4269/ajtmh.2010.09-0440.CrossRef McMorrow M, Masanja M, Kahigwa E, Abdulla S, Kachur P: Quality assurance of rapid diagnostic tests for malaria in routine patient care in rural Tanzania. AmJTrop Med Hyg. 2010, 82: 151-155. 10.4269/ajtmh.2010.09-0440.CrossRef
19.
go back to reference Ishengoma D, Francis F, Mmbando B, Lusingu J, Magistrado P, Alifrangis M, Theander T, Bygbjerg I, Lemge M: Accuracy of rapid diagnostic tests in community studies and their impact on treatment of malaria in an area with declining malaria burden in north-eastern Tanzania. Malar J. 2011, 10: 176-10.1186/1475-2875-10-176.PubMedCentralCrossRefPubMed Ishengoma D, Francis F, Mmbando B, Lusingu J, Magistrado P, Alifrangis M, Theander T, Bygbjerg I, Lemge M: Accuracy of rapid diagnostic tests in community studies and their impact on treatment of malaria in an area with declining malaria burden in north-eastern Tanzania. Malar J. 2011, 10: 176-10.1186/1475-2875-10-176.PubMedCentralCrossRefPubMed
20.
go back to reference Sserwanga A, Harris JC, Kigozi R, Menon M, Bukirwa H, Gasasira A, Kakeeto S, Kizito F, Quinto E, Rubahika D, Nasr S, Filler S, Kamya M, Dorsey G: Improved malaria case management through the implementation of a health facility-based sentinel site surveillance system in Uganda. PLoS One. 2011, 6: e16316-10.1371/journal.pone.0016316.PubMedCentralCrossRefPubMed Sserwanga A, Harris JC, Kigozi R, Menon M, Bukirwa H, Gasasira A, Kakeeto S, Kizito F, Quinto E, Rubahika D, Nasr S, Filler S, Kamya M, Dorsey G: Improved malaria case management through the implementation of a health facility-based sentinel site surveillance system in Uganda. PLoS One. 2011, 6: e16316-10.1371/journal.pone.0016316.PubMedCentralCrossRefPubMed
21.
go back to reference Polage C, Bedu-Addo G, Owusu-Ofori A, Frimpong E, Lloyd W, Zurcher E, Hale D, Petti C: Laboratory use in Ghana: Physician perception and practice. AmJTrop Med Hyg. 2006, 3: 526-531. Polage C, Bedu-Addo G, Owusu-Ofori A, Frimpong E, Lloyd W, Zurcher E, Hale D, Petti C: Laboratory use in Ghana: Physician perception and practice. AmJTrop Med Hyg. 2006, 3: 526-531.
22.
go back to reference Wijesinghe R, Atkinson J, Bobogare A, Lyndes W, Whittaker M: Exploring provider and community responses to the new malaria diagnostic treatment regime in Solomon Islands. Malar J. 2011, 10: 3-10.1186/1475-2875-10-3.PubMedCentralCrossRefPubMed Wijesinghe R, Atkinson J, Bobogare A, Lyndes W, Whittaker M: Exploring provider and community responses to the new malaria diagnostic treatment regime in Solomon Islands. Malar J. 2011, 10: 3-10.1186/1475-2875-10-3.PubMedCentralCrossRefPubMed
23.
go back to reference Asgary R, Grigoryan Z, Naderi R, Allan R: Lack of patient risk counseling and a broader provider training affect malaria control in remote Somalia Kenya border: Qualitative assessment. Global Public Health. 2012, 7: 240-252S. 10.1080/17441692.2011.643412.CrossRefPubMed Asgary R, Grigoryan Z, Naderi R, Allan R: Lack of patient risk counseling and a broader provider training affect malaria control in remote Somalia Kenya border: Qualitative assessment. Global Public Health. 2012, 7: 240-252S. 10.1080/17441692.2011.643412.CrossRefPubMed
24.
go back to reference Reyburn H, Ruanda J, Mwerinde O, Drakeley C: The contribution of microscopy to targeting antimalarial treatment in a low transmission area of Tanzania. Malar J. 2006, 5: 4-10.1186/1475-2875-5-4.PubMedCentralCrossRefPubMed Reyburn H, Ruanda J, Mwerinde O, Drakeley C: The contribution of microscopy to targeting antimalarial treatment in a low transmission area of Tanzania. Malar J. 2006, 5: 4-10.1186/1475-2875-5-4.PubMedCentralCrossRefPubMed
25.
go back to reference Zurovac D, Midia B, Ochola SA, English M, Snow RW: Microscopy and outpatient malaria case management among older children and adults in Kenya. Trop Med Int Health. 2006, 11: 432-440. 10.1111/j.1365-3156.2006.01587.x.CrossRefPubMed Zurovac D, Midia B, Ochola SA, English M, Snow RW: Microscopy and outpatient malaria case management among older children and adults in Kenya. Trop Med Int Health. 2006, 11: 432-440. 10.1111/j.1365-3156.2006.01587.x.CrossRefPubMed
26.
go back to reference Muela S, Ribera J, Mushi A, Tanner M: Medical syncretism with reference to malaria in a Tanzanian community. Soc Sci Med. 2002, 55: 403-413. 10.1016/S0277-9536(01)00179-4.CrossRefPubMed Muela S, Ribera J, Mushi A, Tanner M: Medical syncretism with reference to malaria in a Tanzanian community. Soc Sci Med. 2002, 55: 403-413. 10.1016/S0277-9536(01)00179-4.CrossRefPubMed
27.
go back to reference Harvey S, Jennings L, Chinyama M, Masaninga F, Mulholland K, Bell D: Improving community health worker use of malaria rapid diagnostic tests in Zambia: package instructions, job aid and job aid-plus-training. Malar J. 2008, 7: 160-10.1186/1475-2875-7-160.PubMedCentralCrossRefPubMed Harvey S, Jennings L, Chinyama M, Masaninga F, Mulholland K, Bell D: Improving community health worker use of malaria rapid diagnostic tests in Zambia: package instructions, job aid and job aid-plus-training. Malar J. 2008, 7: 160-10.1186/1475-2875-7-160.PubMedCentralCrossRefPubMed
Metadata
Title
Exploring health providers’ and community perceptions and experiences with malaria tests in South-East Nigeria: a critical step towards appropriate treatment
Authors
Ogochukwu P Ezeoke
Nkoli N Ezumah
Clare CI Chandler
Lindsay J Mangham-Jefferies
Obinna E Onwujekwe
Virginia Wiseman
Benjamin S Uzochukwu
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Malaria Journal / Issue 1/2012
Electronic ISSN: 1475-2875
DOI
https://doi.org/10.1186/1475-2875-11-368

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