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

• Author / Creator

  Boadu, Nana Yaa Agyeman

• 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.

• Subjects / Keywords

  • Malaria
  • diagnosis
  • health systems
  • rapid diagnostic tests
  • RDTs
  • providers' compliance
  • policy
  • Ghana

• Graduation date

  Spring 2014

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/R3R49GG7X

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.