Determinants of malaria testing at health facilities: The case of Uganda

Authors: Ruth N. Kigozi, John Baptist Bwanika, Emily Goodwin, Peter Thomas, Patrick Bukoma, Persis Nabyonga, Fred Isabirye, Paul Oboth, Carol Kyozira, Mame Niang, Kassahun Belay, Gloria Sebikaari, James K. Tibenderana and Sam Siduda Gudoi

These findings underscore the need for malaria control programmes to provide regular supportive supervision to health facilities and training in rapid diagnostic testing.

Background

The World Health Organization (WHO) recommends prompt malaria diagnosis with either microscopy or malaria rapid diagnostic tests (RDTs) and treatment with an effective anti-malarial, as key interventions to control malaria. However, in sub-Saharan Africa, malaria diagnosis is still often influenced by clinical symptoms, with patients and care providers often interpreting all fevers as malaria. The Ministry of Health in Uganda defines suspected malaria cases as those with a fever. A target of conducting testing for at least 75 percent of those suspected to have malaria was established by the National Malaria Reduction Strategic Plan 2014–2020.

Methods

This study investigated factors that affect malaria testing at health facilities in Uganda using data collected in March/April 2017 in a cross-sectional survey of health facilities from the 52 districts that are supported by the US President’s Malaria Initiative (PMI). The study assessed health facility capacity to provide quality malaria care and treatment. Data were collected from all 1085 public and private health facilities in the 52 districts. Factors assessed included supportive supervision, availability of malaria management guidelines, laboratory infrastructure, and training health workers in the use of malaria rapid diagnostic test (RDT). Survey data were matched with routinely collected health facility malaria data obtained from the district health information system Version-2 (DHIS2). Associations between testing at least 75 percent of suspect malaria cases with several factors were examined using multivariate logistic regression.

Results 

Key malaria commodities were widely available; 92 percent and 85 percent of the health facilities reported availability of RDTs and artemether–lumefantrine, respectively. Overall, 933 (86 percent) of the facilities tested over 75 percent of patients suspected to have malaria. Predictors of meeting the testing target were: supervision in the last 6 months (OR: 1.72, 95 percent CI 1.04–2.85) and a health facility having at least one health worker trained in the use of RDTs (OR: 1.62, 95 percent CI 1.04–2.55).

Conclusion 

The study findings underscore the need for malaria control programmes to provide regular supportive supervision to health facilities and train health workers in the use of RDTs.

Published in Malaria Journal

Citation: Malaria Journal, 2021; 20: 456.