title: Improving rational treatment of malaria: perceptions and influence of RDTs on prescribing behaviour of health workers in southeast Nigeria.
abstract: BACKGROUND
  Developments in rapid diagnostic tests (RDTs) have opened new possibilities for improved remote malaria diagnosis that is independent of microscopic diagnosis. Studies in some settings have tried to assess the influence of RDTs on the prescribing behaviour of health workers, but such information is generally lacking in Nigeria and many parts of sub-Saharan Africa. This study analysed health workers' perceptions of RDTs and their potential influence on their prescribing and treatment practices after their introduction.
  
  
  METHODS
  The study was conducted in four health centers in the Enugu East local government of Enugu State, Nigeria. All 32 health workers in the health centers where RDTs were deployed were interviewed by field workers. Information was sought on their perception of symptoms-based, RDT-based, and microscopy-based malaria diagnoses. In addition, prescription analysis was carried out on 400 prescriptions before and 12 months after RDT deployment.
  
  
  RESULTS
  The majority of the health workers perceived RDTs to be more effective for malaria diagnosis than microscopy and clinical diagnosis. They also felt that the benefits of RDTs included increased use of RDTs in the facilities and the tendency to prescribe more Artemisinin-based combination therapies (ACTs) and less chloroquine and SP. Some of the health workers experienced some difficulties in the process of using RDT kits. ACTs were prescribed in 74% of RDT-negative results.
  
  
  CONCLUSIONS
  RDT-supported malaria diagnosis may have led to the overprescription of ACTs, with the drug being prescribed to people with RDT-negative results. However, the prescription of other antimalarial drugs that are not first-line drugs has been reduced. Efforts should be made to encourage health workers to trust RDT results and prescribe ACTs only to those with positive RDT results. In-depth studies are needed to determine why health workers continue to prescribe ACTs in RDT-negative results.
authors.affiliation: Department of Community Medicine, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Nigeria. bscuzochukwu@yahoo.com
authors.forename: Benjamin S C
authors.initials: BS
authors.lastname: Uzochukwu
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Onwujekwe
authors.forename: Nkoli N
authors.initials: NN
authors.lastname: Ezuma
authors.forename: Ogochukwu P
authors.initials: OP
authors.lastname: Ezeoke
authors.forename: Miriam O
authors.initials: MO
authors.lastname: Ajuba
authors.forename: Florence T
authors.initials: FT
authors.lastname: Sibeudu
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use; D037621:Artemisinins / Q000627:therapeutic use; D003150:Community Health Workers / Q000592:standards*; D003955:Diagnostic Tests, Routine / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008288:Malaria / Q000188:drug therapy*; D009549:Nigeria; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D011933:Reagent Kits, Diagnostic
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D011933:Reagent Kits, Diagnostic; C031327:artemisinin