Background

To avoid misuse of anti-malarials, correct diagnosis of fever prior to drug prescription is essential. Presumptive treatment in the private healthcare sector is a concern in Nigeria, where availability of afordable artemisinin-based combination therapy (ACT) is high following the implementation of subsidy schemes from 2010 to 2017. Similar subsidies have not, however, been implemented for malaria rapid diagnostic tests (RDTs). A market survey in 2018 predominantly designed to assess the ACT market in the private sector also collected data related to RDTs, results of which are presented herein.

Methods

A 2018 market survey consisted of (i) an outlet survey targeting private pharmacies and Proprietary and Patent Medicine Vendors (PPMVs) across diferent regions of Nigeria to assess supply-side market factors related to availability of RDTs (defned as having stock available for purchase at the time of the survey) and (ii) a household survey to determine demand-side factors related to knowledge of RDTs, healthcare-seeking practices and affordability.

Results

Availability of RDTs at the time of the survey was low in both outlet types and signifcantly lower in PPMVs (22.1 percent, 95 percent CI) among pharmacies versus (13.6 percent, 95 percent CI) among PPMVs (p<0.01). Reasons for not restocking RDTs included low demand and no supply. The majority of households diagnose malaria based on experience, while one third would visit a PPMV or pharmacy. Half of households had heard of RDTs (48.4 percent) and 38.6 percent thought they were affordable.

Conclusions

Low availability of RDTs among PPMVs and pharmacies may be attributed to lack of demand, supply-side issues and cost. Increasing household knowledge of RDTs may aid increasing demand, while subsidized RDTs may address supply and price issues. Addressing the defcit in RDT provision is important for targeting of ACT medicines.

Published in Malaria Journal 

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Country: Nigeria