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Using Malaria Rapid Diagnostic Tests in Ghana: Understanding Healthcare Providers' Compliance with Policy Guidelines for Malaria Diagnosis in Peripheral Facilities Open Access


Other title
Malaria, diagnosis, health systems, rapid diagnostic tests, RDTs, providers' compliance, policy, Ghana
Type of item
Degree grantor
University of Alberta
Author or creator
Boadu, Nana Yaa Agyeman
Supervisor and department
Higginbottom, Gina (Faculty of Nursing)
Yanow, Stephanie (Public Health Sciences)
Examining committee member and department
Einsedel, Edna (Communication and Culture, University of Calgary)
Houston, Stan (Medicine)
Whittaker, Maxine (Population Health, University of Queensland)
Menon, Dev (Health Policy)
Department of Public Health Sciences

Date accepted
Graduation date
Doctor of Philosophy
Degree level
Financing and implementation of malaria control measures expanded vastly over the past decade, leading to substantial reductions in global malaria morbidity and mortality. Yet malaria still threatens health and socio-economic development among the poorest populations particularly in sub-Saharan Africa, where limited health systems capacity hampers effective control. Early diagnosis and effective treatment are essential to reduce the disease burden. Expert microscopy - the gold standard for malaria diagnosis - is unsustainable in remote settings with limited laboratory infrastructure. Rapid Diagnostic Tests (RDTs) enable parasite-based diagnosis in these settings and are widely deployed across sub-Saharan African countries including Ghana. However, presumptive treatment based on the presence of fever persists across the region, leading to rampant over-diagnosis of malaria and consequent over-consumption of antimalarials. Inappropriate antimalarial use contributes to emerging drug resistance, threatens the feasibility of expanding treatment access among affected populations, and undermines the effectiveness of malaria control measures. The World Health Organization recommends diagnostic confirmation of suspected malaria cases prior to antimalarial treatment. Ghana adopted this guideline in 2009 and employed RDT use to support guideline implementation. However, RDT use is beset with operational challenges including poor compliance among healthcare providers with the test-before-treat guideline. Poor compliance has been reported in Ghana and is widespread across sub-Saharan Africa. Although guideline compliance is central to the successful implementation of test-based malaria management in these settings, its underlying factors are barely understood. In this thesis, I investigated healthcare providers’ compliance with the test-before-treat guideline for malaria in Ghana. I present this research in three consecutive and complementary papers. Chapter 1 comprises a review of the literature on barriers and facilitators regarding RDT use for malaria diagnosis across sub-Saharan Africa. In Chapter 2, I illustrate the significance of the qualitative approach I employed to investigate guideline compliance for confirmatory malaria testing in Ghana. In Chapter 3, I identify and explain the determinants of guideline compliance from the healthcare providers’ perspective. Uncomplicated malaria in Ghana is managed within the jurisdiction of primary healthcare. The findings of this research therefore pertain to improving guideline compliance for malaria management within primary healthcare settings in Ghana.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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