title: Attitudes toward home-based malaria testing in rural and urban Sierra Leone.
abstract: BACKGROUND
  The purpose of this study was to examine malaria testing practices and preferences in Bo, Sierra Leone, and to ascertain interest in and willingness to take a home-based rapid diagnostic test administered by a community health volunteer (CHV) or a trained family member rather than travelling to a clinical facility for laboratory-based testing.
  
  
  METHODS
  A population-based, cross-sectional survey of 667 randomly-sampled rural households and 157 urban households was conducted in December 2013 and January 2014.
  
  
  RESULTS
  Among rural residents, 69% preferred a self/family- or CHV-conducted home-based malaria test and 20% preferred a laboratory-based test (with others indicating no preference). Among urban residents, these numbers were 38% and 44%, respectively. If offered a home-based test, 28% of rural residents would prefer a self/family-conducted test and 68% would prefer a CHV-assisted test. For urban residents, these numbers were 21% and 77%. In total, 36% of rural and 63% of urban residents reported usually taking a diagnostic test to confirm suspected malaria. The most common reasons for not seeking malaria testing were the cost of testing, waiting to see if the fever resolved on its own, and not wanting to travel to a clinical facility for a test. In total, 32% of rural and 27% of urban participants were very confident they could perform a malaria test on themselves or a family member without assistance, 50% of rural and 62% of urban participants were very confident they could perform a test after training, and 56% of rural and 33% of urban participants said they would pay more for a home-based test than a laboratory-based test.
  
  
  CONCLUSIONS
  Expanding community case management of malaria to include home testing by CHVs and family members may increase the proportion of individuals with febrile illnesses who confirm a positive diagnosis prior to initiating treatment.
authors.affiliation: Department of Global and Community Health, George Mason University, 4400 University Drive 5B7, Fairfax, VA, 22030, USA. sranasi3@gmu.edu.
authors.forename: Shamika
authors.initials: S
authors.lastname: Ranasinghe
authors.affiliation: Mercy Hospital Research Laboratory, Bo, Sierra Leone. rashidansumana@gmail.com.|Njala University, Bo, Sierra Leone. rashidansumana@gmail.com.|Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK. rashidansumana@gmail.com.
authors.forename: Rashid
authors.initials: R
authors.lastname: Ansumana
authors.affiliation: Mercy Hospital Research Laboratory, Bo, Sierra Leone. jm_lamin@yahoo.com.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Lamin
authors.affiliation: Mercy Hospital Research Laboratory, Bo, Sierra Leone. asbock2@yahoo.com.|Njala University, Bo, Sierra Leone. asbock2@yahoo.com.
authors.forename: Alfred S
authors.initials: AS
authors.lastname: Bockarie
authors.affiliation: Mercy Hospital Research Laboratory, Bo, Sierra Leone. umarbans@yahoo.co.uk.
authors.forename: Umaru
authors.initials: U
authors.lastname: Bangura
authors.affiliation: Mercy Hospital Research Laboratory, Bo, Sierra Leone. jagbuanie@gmail.com.
authors.forename: Jacob A G
authors.initials: JA
authors.lastname: Buanie
authors.affiliation: US Naval Research Laboratory, Washington, DC, 20375, USA. david.stenger@nrl.navy.mil.
authors.forename: David A
authors.initials: DA
authors.lastname: Stenger
authors.affiliation: Department of Global and Community Health, George Mason University, 4400 University Drive 5B7, Fairfax, VA, 22030, USA. kjacobse@gmu.edu.
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Jacobsen
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D003153:Community Health Services / Q000379:methods* / Q000706:statistics & numerical data*; D003150:Community Health Workers; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008288:Malaria / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011933:Reagent Kits, Diagnostic; D012424:Rural Population / Q000706:statistics & numerical data; D012807:Sierra Leone; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D011933:Reagent Kits, Diagnostic