title: An assessment of malaria diagnostic capacity and quality in Ghana and the Republic of Benin.
abstract: BACKGROUND
  In malaria-endemic countries, the absence of parasitological confirmation of malaria infection potentially results in overtreatment of non-malaria febrile illness with antimalarial drugs; this may lead to healthcare workers (HCW) missing other treatable illness or wastage of resources. This paper presents results from nationally representative assessments of malaria diagnostic accuracy, quality and capacity in Ghana and the Republic of Benin.
  
  
  METHODS
  Cross-sectional surveys were conducted in December 2012 among a representative sample of health facilities (n=30 per country), using a modified service provision assessment, followed by HCW observations and interviews. To analyze the data we used χ(2) statistics and logistic regression.
  
  
  RESULTS
  Malaria microscopy and rapid diagnostic test interpretation was accurate most of the time in both countries. Drugs were generally prescribed in line with positive malaria test results (Ghana: 85.4%, 95% CI: 72.2-98.7; Benin: 83.6%, 95% CI: 68.7-98.4), although some patients with negative malaria test results still received treatment (Ghana: 30.1%, 95% CI: 11.1-49.0; Benin: 37.8%, 95% CI: 22.6-53.0).
  
  
  CONCLUSIONS
  Diagnostics for malaria are often performed adequately and accurately in Ghana and Benin, although diagnostic coverage within facilities remains incomplete and some individuals who test negative for malaria receive antimalarial drugs.
authors.affiliation: Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans LA 70112, USA jkeating@tulane.edu.
authors.forename: Joseph
authors.initials: J
authors.lastname: Keating
authors.affiliation: Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans LA, USA.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Finn
authors.affiliation: Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans LA 70112, USA.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Eisele
authors.affiliation: DERMED Consult LLC, Tamale, Ghana.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Dery
authors.affiliation: Clinical Laboratory Unit, Institutional Care Division, Ghana Health Service, Korle-Bu, Accra, Ghana.
authors.forename: Ekow
authors.initials: E
authors.lastname: Biney
authors.affiliation: Institut des Sciences Biomédicales Appliquées (ISBA), Cotonou, Benin.
authors.forename: Marius
authors.initials: M
authors.lastname: Kêdoté
authors.affiliation: Institut des Sciences Biomédicales Appliquées (ISBA), Cotonou, Benin.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Fayomi
authors.affiliation: Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans LA 70112, USA.
authors.forename: Joshua O
authors.initials: JO
authors.lastname: Yukich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000627:therapeutic use; D001541:Benin; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000592:standards*; D005260:Female; D005869:Ghana; D006302:Health Services Research; D006801:Humans; D016015:Logistic Models; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008853:Microscopy / Q000592:standards; D008875:Middle Aged; D018512:Parasitemia / Q000175:diagnosis; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D000962:Antimalarials
keywords: Benin; Diagnostic; Ghana; Health facility; Malaria; Rapid assessment