ASSESSMENT OF MALARIA RAPID DIAGNOSTIC TEST AND UTILISATION OF LABORATORY SERVICES FOR MALARIA DIAGNOSIS AT MAKARFI GENERAL HOSPITAL, KADUNA STATE
ASSESSMENT OF MALARIA RAPID DIAGNOSTIC TEST AND UTILISATION OF LABORATORY SERVICES FOR MALARIA DIAGNOSIS AT MAKARFI GENERAL HOSPITAL, KADUNA STATE
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Date
2012-08
Authors
AJUMOBI, OLUFEMI OLAMIDE
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Abstract
In Nigeria, malaria accounts for 30% mortality in children <5years (U5). World Health
Organisation guidelines recommend parasite-based diagnosis prior to commencement of
antimalarial treatment. However, empirical treatment remains a common phenomenon at homes
and in clinical settings because of presumed high malaria prevalence. This is compounded by
inadequate information on accuracy of malaria rapid diagnostic test (RDT). Data on factors
affecting the utilisation of malaria laboratory services (MLS) is not readily available. We
conducted a study to assess the diagnostic accuracy of Standard Diagnostic (SD) Bioline malaria
rapid diagnostic test, and to determine the factors affecting the utilisation of MLS in febrile
children in Kaduna State, Northern Nigeria.
We conducted a cross-sectional study of 296 caregivers of febrile U5 at Makarfi General
Hospital (MGH), Kaduna state from December 2010 to August 2011. We used structured
questionnaires to collect data on socio-demographics of caregivers, clinical information on
febrile U5, and utilisation of MLS. Blood samples were collected from 296 U5 and examined for
malaria parasites with SD Bioline rapid diagnostic test (RDT) and routine microscopy. The
diagnostic accuracy of the RDT was determined. Focus group discussions (n=4) were conducted
at Makarfi communities to determine the factors affecting utilisation of MLS among caregivers
of children U5. Eight key informants were interviewed to determine the capacity for malaria
diagnosis at MGH.
VII
The sensitivity, specificity, negative and positive predictive values of SD Bioline RDT were
100%, 98.5%, 100% and 88.6% respectively. The prevalence of malaria in the febrile children
was 10.5% and 11.8% by RDT and microscopy respectively. Plasmodium falciparum infection
rate was 100%. Overall, 3.7% of caregivers were offered any malaria laboratory test by health
staff and 5.5% have ever heard about MLS. Non-request of MLS by health staff, lack of
awareness, presumptive treatment, and long distance from health centre, caregiver’s perceived
severity of illness, high cost, and non-availability of MLS were responsible for poor utilization of
malaria laboratory services. Lack of trained staff, basic reagents for malaria microscopy and
quality assurance mechanisms were responsible for poor capacity for malaria diagnosis at MGH.
SD Bioline RDT has a high sensitivity and specificity despite low prevalence of malaria. This
strongly precludes the current practice of presumptive treatment of fever in U5. SD Bioline RDT
should be rapidly deployed to all health facilities where there are no facilities for microscopy.
Kaduna state and Makarfi local government should sensitise health care providers on
confirmatory malaria diagnosis in children. They should sensitise caregivers in rural
communities about utilization of MLS. Equally, they should provide access to MLS at an
affordable cost in rural communities and urgently strengthen capacity for MLS.
Key words: malaria, sensitivity, laboratory services, rapid diagnostic test, Nigeria.
Description
A DISSERTATION SUBMITTED TO THE POSTGRADUATE SCHOOL OF
THE AHMADU BELLO UNIVERSITY ZARIA
NIGERIA
IN PARTIAL FULFILLMENT FOR THE AWARD OF MASTER OF PUBLIC
HEALTH - FIELD EPIDEMIOLOGY
DEPARTMENT OF COMMUNITY MEDICINE
FACULTY OF MEDICINE
AHMADU BELLO UNIVERSITY ZARIA
NIGERIA
AUGUST, 2012.
Keywords
ASSESSMENT,, MALARIA, RAPID,, DIAGNOSTIC TEST, UTILISATION,, LABORATORY,, MALARIA DIAGNOSIS,, MAKARFI GENERAL HOSPITAL,, KADUNA STATE.