Factors Influencing Utilization of Malaria Rapid Diagnostic Tests in Chipata District's Rural, Peri-Urban and Urban Health Centers in Eastern Province

Abstract

Rapid and accurate diagnosis is fundamental to effective management and control of malaria. In Zambia the Integrated Technical Guidelines (ITG) for Frontline Heath Workers and the National Integrated Management of Child Illnesses (IMCI) framework stipulate how malaria should be managed. Challenges have been identified with respect to delays and inaccuracy in malaria diagnosis. This study aims at determining the level of utilization and the factors that contribute to utilization of Malaria Rapid Diagnostic Tests (MRDTs) at the district health centres A Cross-sectional research study was conducted in Chipata's 13 district health centres and were sampled proportionate to size using rotary technique. A sample of 42 health workers who routinely diagnosed malaria using RDT were interviewed using provider interview questionnaire and a records review of a sample of 26 facility records generated from January 1st to June 30th 2009 was done using a checklist. A sample of 13 Non participant observations were done on each health worker performing MRDTs on the assessment day in all the selected health centres. Qualitative data was analysed using NVIVO software version 2.1 computer package and quantitative data was analysed using the SPSS computer package version 17.RDT utilisation in the 13 heath centres was above the 2008 district reference level of 30%, The M RDT group utilization was 64 (± 1SD = 5.99). The lowest utilisation value was 55% and the highest was 73.10%. There was not a time when all the guidelines (ITG, IMCI and Job aid) were available in the selected centres. 21(50 %) of the health workers interviewed were trained, only 4 (30.8%) workers demonstrated high skill for health practice. Out of 42 health workers 2 (5%) had regular supervisions and 40 (95%) had irregular supervisions. The p group knowledge was 4.66 (± SD 1.66) as the average knowledge level was graded at 4- 6. In all the health centers there was at least one staff designated to perform MRDTs every day. Staff attitudes towards MRDTs were, poor n= 27 (64.3%), average n =13 (40%) and good n= 2 (5%).The RDT program in Chipata District is yet to meet the set national target of 80% utilization rate. There is need for well-designed technical support supervision program, improved practice (skill), provision of guidelines as well as training to ensure high RDT utilization in areas where microscopy is unavailable or not practical.