ABSTRACT
Background: Morbidity and mortality resulting from malaria remains a serious obstacle for social and economic development. Accurate diagnosis and prompt treatment are therefore essential components of case management strategy. The aim of this study therefore was to examine the diagnostic procedure of uncomplicated malaria, and patients’ understanding and satisfaction of treatment in Community Health Care Facilities, three years after the deployment of Malaria Rapid Diagnostic Tests in Ghana. Methodology: A prospective and data collation was done randomly, by means of cluster and stratified multistage surveyat three government hospitals and three private pharmacies in Kumasi, Ghana, between July and September, 2013. Patients treated for uncomplicated malaria, while leaving the health facility, upon consent, were selected and requested to answer questionnaires which served as a source of data to address the objective of the study. Bivariate statistics from the SPSS v 19 was employed to predict the relationships between health institutions and mode of diagnosis, patients’ understanding and satisfaction of services. Results: Fifty-three (53) out of 65 patients responded. The study indicated presumptive diagnosis [44 (83.0%)] to be predominantly used over test-based diagnosis [9 (17.0%)]. The mean age of patients was 34.44±14.8 years (Range 17-66). Out of 52 patients who provided information on educational level, those with tertiary education were 24 (46.2%), secondary were 9 (17.3%), primary were 14 (26.9%) and no formal education were 14 (26.9%). Male patients were 25 (47.2%) and female 28 (52.8%). All 53 patients were given Artemisinin-based Combination Therapy at the various health facilities. Of 35 patients at hospitals/clinics, 15 (42.9%) rated “very good value” to explain their understanding and satisfaction of services provided, and of 18 patients from private pharmacies, 10 (55.6%) rated as “very good value”. Patients with tertiary education [14/25 (56.0%)] showed better understanding and satisfaction of services than those with no formal education [1/25 (4.0%)]. Not a single use of Malaria Rapid Diagnostic Tests for diagnosis was recorded. Conclusion: Diagnosis of malaria at the periphery of health systems is still mainly presumptive three years after deployment of the Malaria Rapid Diagnostic Test. Patients’ good rating on the diagnosis of uncomplicated malaria at private pharmacies, should be an advantage to introducing the Malaria Rapid Diagnostic Tests by healthcare practitioners.
ABSTRACT
Aims: In much of Africa, Ghana inclusive, malaria has traditionally been diagnosed and treated presumptively: any patient with fever was presumed to have malaria and treated with antimalarial drugs. In this study, the retail pharmacies practitioners’ perspectives on the implementation of Malaria Rapid Diagnostic Tests was sought and decisions analyzed in themes, using Realist Conceptual Approach. Study Design: Cross-sectional quantitative and purposive study. Place and Duration of Study: Registered private pharmacies in Ashanti Region of Ghana, between September and November, 2013. Methodology: A structured pre-tested questionnaires (in non-study area) was selfadministered to 99 practitioners in retail pharmacies to generated information on Practitioner’s characteristics, knowledge and experience on the MRDT kits, acceptance and willingness to use the test kits and challenge towards the use of the kit, for the thematic analysis. Results: Practitioners within the age bracket of 30-40 years were highest (43%) and male representation was 67%. Pharmacists were 67% of practitioners and 17.1% had postgraduate qualification. 96.03% had ample knowledge of test kit and 0.99% use it always and logistic regression indicated no significance (Chi-square=0.751; LR=0.540 at p<0.05). Of the patients, 47.52% strongly agree to implement and 48.51 agree. 60.39% were definite to suggest to colleague and logistic regression indicated significant relation (Chi-square=0.000; LR=0.006 at p<0.05). 44.4% were very satisfied with presumptive diagnosis while 1% very dissatisfied. Conclusion: The findings indicated willingness to implement the policy but presumptive diagnosis is still the practice. The evidence provides an opportunity to adapt a conceptual framework leading to the uptake of the policy.