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A study conducted in Nigeria has shown that health providers continue to prescribe malaria medicines inappropriately, even after they learn to test for malaria and receive testing kits free of charge.
Health providers were given rapid diagnostic tests (RDT) for malaria and learned to use the tests via 3 different methods.
However, the use of RDTs was “critically low” in all 3 groups, as was the proportion of patients treated appropriately.
“This study confirms that treating malaria based on signs and symptoms alone remains an ingrained behavior that is difficult to change,” said Obinna Onwujekwe, MD, PhD, of the University of Nigeria in Enugu.
Dr Onwujekwe and his colleagues reported these findings in PLOS ONE.
Interventions
Their study included health workers and patients from 40 communities in the Nigerian state of Enugu. Health workers received free RDT kits and were taught to use the tests in 3 different ways.
The first group received comprehensive RDT training, which included instructions on how to use an RDT, guidelines on malaria diagnosis and treatment, information about other causes of fever, and help with communications skills, especially for patients whose test results were negative.
The second group received the same training plus a school-based intervention that involved training 2 teachers per school. The aim was to influence the attitudes of school children and their families as well as the wider community.
And health workers in the third group—the control arm—were invited to a demonstration and practical on how to safely use RDTs and supplied with written instructions on their use.
Results
The primary outcome was the proportion of patients who were treated according to guidelines. In other words, they presented with symptoms consistent with malaria, were tested for malaria, and received treatment consistent with the test result.
The researchers assessed the primary outcome in 4946 patients from 40 communities—12 in the control arm and 14 in each intervention arm.
There was no significant difference between the arms with regard to this outcome. The proportion of patients treated according to guidelines was 36% in the comprehensive training arm, 24% in the training-school arm, and 23% in the control arm (P=0.36).
Likewise, the use of testing was low in all arms—34% in the control arm, 48% in the training arm, and 37% in the training-school arm (P=0.47).
The use of testing was lower at private facilities than public ones. Cost may have been a factor here, as public facilities were asked to offer testing free of charge, but private facilities could charge 100 Naira (0.6 USD).
“We have shown that training alone is not enough to realize the full potential of an RDT,” said Virginia Wiseman, PhD, of the London School of Hygiene & Tropical Medicine in the UK.
“We must continue to explore alternative ways of encouraging providers to deliver appropriate treatment and avoid the misuse of valuable medicines, especially in the private sector, where we found levels of testing to be lowest.” 
Photo courtesy of USAID
A study conducted in Nigeria has shown that health providers continue to prescribe malaria medicines inappropriately, even after they learn to test for malaria and receive testing kits free of charge.
Health providers were given rapid diagnostic tests (RDT) for malaria and learned to use the tests via 3 different methods.
However, the use of RDTs was “critically low” in all 3 groups, as was the proportion of patients treated appropriately.
“This study confirms that treating malaria based on signs and symptoms alone remains an ingrained behavior that is difficult to change,” said Obinna Onwujekwe, MD, PhD, of the University of Nigeria in Enugu.
Dr Onwujekwe and his colleagues reported these findings in PLOS ONE.
Interventions
Their study included health workers and patients from 40 communities in the Nigerian state of Enugu. Health workers received free RDT kits and were taught to use the tests in 3 different ways.
The first group received comprehensive RDT training, which included instructions on how to use an RDT, guidelines on malaria diagnosis and treatment, information about other causes of fever, and help with communications skills, especially for patients whose test results were negative.
The second group received the same training plus a school-based intervention that involved training 2 teachers per school. The aim was to influence the attitudes of school children and their families as well as the wider community.
And health workers in the third group—the control arm—were invited to a demonstration and practical on how to safely use RDTs and supplied with written instructions on their use.
Results
The primary outcome was the proportion of patients who were treated according to guidelines. In other words, they presented with symptoms consistent with malaria, were tested for malaria, and received treatment consistent with the test result.
The researchers assessed the primary outcome in 4946 patients from 40 communities—12 in the control arm and 14 in each intervention arm.
There was no significant difference between the arms with regard to this outcome. The proportion of patients treated according to guidelines was 36% in the comprehensive training arm, 24% in the training-school arm, and 23% in the control arm (P=0.36).
Likewise, the use of testing was low in all arms—34% in the control arm, 48% in the training arm, and 37% in the training-school arm (P=0.47).
The use of testing was lower at private facilities than public ones. Cost may have been a factor here, as public facilities were asked to offer testing free of charge, but private facilities could charge 100 Naira (0.6 USD).
“We have shown that training alone is not enough to realize the full potential of an RDT,” said Virginia Wiseman, PhD, of the London School of Hygiene & Tropical Medicine in the UK.
“We must continue to explore alternative ways of encouraging providers to deliver appropriate treatment and avoid the misuse of valuable medicines, especially in the private sector, where we found levels of testing to be lowest.”
Photo courtesy of USAID
A study conducted in Nigeria has shown that health providers continue to prescribe malaria medicines inappropriately, even after they learn to test for malaria and receive testing kits free of charge.
Health providers were given rapid diagnostic tests (RDT) for malaria and learned to use the tests via 3 different methods.
However, the use of RDTs was “critically low” in all 3 groups, as was the proportion of patients treated appropriately.
“This study confirms that treating malaria based on signs and symptoms alone remains an ingrained behavior that is difficult to change,” said Obinna Onwujekwe, MD, PhD, of the University of Nigeria in Enugu.
Dr Onwujekwe and his colleagues reported these findings in PLOS ONE.
Interventions
Their study included health workers and patients from 40 communities in the Nigerian state of Enugu. Health workers received free RDT kits and were taught to use the tests in 3 different ways.
The first group received comprehensive RDT training, which included instructions on how to use an RDT, guidelines on malaria diagnosis and treatment, information about other causes of fever, and help with communications skills, especially for patients whose test results were negative.
The second group received the same training plus a school-based intervention that involved training 2 teachers per school. The aim was to influence the attitudes of school children and their families as well as the wider community.
And health workers in the third group—the control arm—were invited to a demonstration and practical on how to safely use RDTs and supplied with written instructions on their use.
Results
The primary outcome was the proportion of patients who were treated according to guidelines. In other words, they presented with symptoms consistent with malaria, were tested for malaria, and received treatment consistent with the test result.
The researchers assessed the primary outcome in 4946 patients from 40 communities—12 in the control arm and 14 in each intervention arm.
There was no significant difference between the arms with regard to this outcome. The proportion of patients treated according to guidelines was 36% in the comprehensive training arm, 24% in the training-school arm, and 23% in the control arm (P=0.36).
Likewise, the use of testing was low in all arms—34% in the control arm, 48% in the training arm, and 37% in the training-school arm (P=0.47).
The use of testing was lower at private facilities than public ones. Cost may have been a factor here, as public facilities were asked to offer testing free of charge, but private facilities could charge 100 Naira (0.6 USD).
“We have shown that training alone is not enough to realize the full potential of an RDT,” said Virginia Wiseman, PhD, of the London School of Hygiene & Tropical Medicine in the UK.
“We must continue to explore alternative ways of encouraging providers to deliver appropriate treatment and avoid the misuse of valuable medicines, especially in the private sector, where we found levels of testing to be lowest.”