Compliance of health workers with malaria rapid diagnostic test guidelines in Rukungiri District, Uganda

Abstract

Introduction and background: Rapid diagnostic tests (RDTs) for diagnosis of malaria were introduced in November 2008 and rolled out to all health centre (HC) of level II in Rukungiri district. Before their introduction, health workers used presumptive clinical means for diagnosing and treating malaria. RDTs are cost effective and reduce errors in treatment if the prescribers comply with the test results. This study assessed the knowledge and compliance of health workers to RDT guidelines for diagnosis and management of malaria in Rukungiri district. Methods: The study used both cross sectional and retrospective designs. Twenty three HCs from the entire district were selected by simple random sampling. A total of 460 cases at the selected HCs that had an RDT test for malaria were selected by simple random sampling from patient registers. Data abstracted included client particulars, RDT results and drugs prescribed. Key informant interviews were conducted with health workers. Data was analysed using SPSS version 11.0. Results: All health workers who manage patients in the sampled health centres knew the type of patients to be tested for malaria using RDTs, the procedure of conducting a RDT on a patient and management of patients after a RDT result. Of all 460 patients seen at health facilities, a third (31%) were managed in compliance with the national RDT guidelines. 79% of the patients tested with RDTs had fever, cough, flu and headache. Patients who were more likely to receive and anti-malarial were: those that presented with fever (OR: 56.1, 95% CI: 28.5 – 110); had a positive RDT result (OR: 401, 95% CI: 142.9 – 1000). The mean compliance score for all health facilities was 10.19 (SD 1.3), median score was 10 (Range 8.0 - 15). Conclusion and recommendations: Knowledge of health workers of the RDT guidelines was high; however, compliance was still sub-optimal in patient examination. District health authorities should actively monitor the health workers’ implementation of the RDT policy guidelines and respond to unmet needs.