title: An exploratory study of factors that affect the performance and usage of rapid diagnostic tests for malaria in the Limpopo Province, South Africa.
abstract: BACKGROUND
  Malaria rapid diagnostic tests (RDTs) are relatively simple to perform and provide results quickly for making treatment decisions. However, the accuracy and application of RDT results depends on several factors such as quality of the RDT, storage, transport and end user performance. A cross sectional survey to explore factors that affect the performance and use of RDTs was conducted in the primary care facilities in South Africa.
  
  
  METHODS
  This study was conducted in three malaria risk sub-districts of the Limpopo Province, in South Africa. Twenty nurses were randomly selected from 17 primary health care facilities, three nurses from hospitals serving the study area and 10 other key informants, representing the managers of the malaria control programmes, routine and research laboratories, were interviewed, using semi-structured questionnaires.
  
  
  RESULTS
  There was a high degree of efficiency in ordering and distribution of RDTs, however only 13/20 (65%) of the health facilities had appropriate air-conditioning and monitoring of room temperatures. Sixty percent (12/20) of the nurses did not receive any external training on conducting and interpreting RDT. Fifty percent of nurses (10/20) reported RDT stock-outs. Only 3/20 nurses mentioned that they periodically checked quality of RDT. Fifteen percent of nurses reported giving antimalarial drugs even if the RDT was negative.
  
  
  CONCLUSIONS
  Storage, quality assurance, end user training and use of RDT results for clinical decision making in primary care facilities in South Africa need to be improved. Further studies of the factors influencing the quality control of RDTs, their performance of RDTs and the ways to improve their use of RDTs are needed.
authors.affiliation: Disease Control and Vector Biology Unit, London School of Hygiene and Tropical Medicine, London, UK. Patrick.moonasar@lshtm.ac.uk
authors.forename: Devanand
authors.initials: D
authors.lastname: Moonasar
authors.forename: Ameena Ebrahim
authors.initials: AE
authors.lastname: Goga
authors.forename: John
authors.initials: J
authors.lastname: Frean
authors.forename: Philip
authors.initials: P
authors.lastname: Kruger
authors.forename: Daniel
authors.initials: D
authors.lastname: Chandramohan
mesh_terms: D006801:Humans; D008288:Malaria / Q000175:diagnosis* / Q000453:epidemiology; D011785:Quality Assurance, Health Care; D011933:Reagent Kits, Diagnostic / Q000592:standards* / Q000706:statistics & numerical data*; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors
chemical_list: D011933:Reagent Kits, Diagnostic