Use of Rapid Diagnostics Test Kits can improve rational drug prescription among Primary Health Care workers in low income setting

A Poster Presentation at the 61st Annual Meeting of the American Society of Tropical Medicine and Hygiene, 11-15 November 2012, Atlanta.
Bright C. Orji1, William R. Brieger2, Emmanuel Otolorin1, Nancy Ali1, Jones Nwadike3 – 1Jhpiego/JHU, Baltimore, MD, United States, 2The Johns Hopkins University, Baltimore, MD, United States, 3Dunamis Diagnostic Services, Lagos, Nigeria

checking-records.jpgCurrent efforts to reduce burden of uncomplicated malaria among children under-five years old in low income countries is undermined by presumptive treatment of the disease. Proper and early diagnosis of malaria using Rapid Diagnostic Tests (RDTs) in integrated case management may restrict inappropriate use of anti-malarial medicines to children.

This observational study documented diagnostic and treatment patterns for febrile illness management in local government clinics in Akwa Ibom State, Nigeria before and after introduction of RDTs. Audit of outpatient client records before and after RDT introduction was conducted in six primary health care facilities in two Local Government Areas, Onna and Ibeno by three trained nurses.

A total of 1003 children presented with fever prior to RDT introduction, and 90.3% were presumptively treated with anti-malarial medicines; 66.1% also received antibiotics. After the introduction RDTs, records of 800 children who presented with fever were reviewed and 90.9% were tested using RDTs with 41.5% of 720 being confirmed cases of malaria. Of children with positive RDTs results 95.6 received anti-malarial medicines. Among those with RDTs negative results 22.9% received anti-malarial medicines while 88.7% got antibiotics.

The study supports the use of RDTs for febrile illness testing to aid adherence of health workers to integrated child treatment protocols. Though there is still a gap in prescribing behavior, this can be corrected through supervision and ongoing performance quality tools.

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