Abstract:

Background: Available evidence indicates poor adherence to malaria rapid diagnostic tests results among health workers with patients having negative results being prescribed with antimalarial. The present study aimed at assessing the impact of introducing malaria rapid diagnostic tests at clinical point of care if it will improve adherence to test results and reduce over prescription of antimalarial.

Method: This was a non-randomized intervention trial conducted in two (2) district hospitals of Urambo and Nzega, Tabora region from July to September 2016. Clinicians from Urambo district hospital (Intervention arm) were trained on how to diagnose malaria suspect patients attending at the hospital. Clinician at Nzega district hospital (control arm) continued with routine ordering for malaria testing using malaria rapid diagnostic tests from medical laboratory.

Results: A total of 593 malaria suspected patients were recruited into study (330 in the intervention arm and 263 in the control arm), of these, 49.4% (n=293) and 50.6% (n=300) were females and males respectively. The median age of study participants was 19 [IQR: 4-32] years with majority of study participants aged 1-10 years (38.3%). For the intervention arm (Urambo district hospital), 17.9% (n=59) of study participants had positive test and 20.2% (n=53) in the control arm (Nzega district hospital) had positive results who received antimalarial. The proportional of malaria rapid diagnostic test negative results who received antimalarial in the intervention arm was 4.8% (n=13) and in the control arm was 20.4% (n=43). Introduction of malaria rapid diagnostic test at clinical point of care reduced the odd of receiving antimalarial among malaria suspect patients who tested negative for the disease by 15.6% (X2 =28.2749, P<0.0001). At Bivariable and multivariable analysis in intervention arm having history of fever (OR=5.26, 95%CI: 1.84-15.02, P<0.002), presumptive diagnosis of anaemia (pallor) (OR=12.85, 95%CI: 4.96-33.32, P<0.01), history of vomiting (OR=2.70, 95%CI: 1.52-4.81, P<0.001) presumptive diagnosis of severe malaria (OR=38.96, 95%CI: 16.3-93.01, P<0.001) and in control arm; age group between 1-10 years (OR=4.69, 95%CI: 1.36-16.15, P<0.01), history of vomiting (OR=4.64, 95%CI: 2.31 – 9.34, P<0.001) presumptive diagnosis of severe malaria (OR=3.74, 95%CI: 1.96 – 7.14, P<0.001) were independently associated with prescription of antimalarial to patients with malaria rapid diagnostic test negative results. Factors which appeared to be significantly associated with over prescription in both arms history of vomiting and presumptive diagnosis of severe malaria.

Conclusion: In this intervention trial, provision of malaria rapid diagnostic test at clinical point of care significantly contributed to reduction in prescription of antimalarial to patients with negative results.