title: Status of the use and compliance with malaria rapid diagnostic tests in formal private health facilities in Nigeria.
abstract: BACKGROUND
  Nigeria has the largest number of malaria-related deaths, accounting for a third of global malaria deaths. It is important that the country attains universal coverage of key malaria interventions, one of which is the policy of universal testing before treatment, which the country has recently adopted. However, there is a dearth of data on its implementation in formal private health facilities, where close to a third of the population seek health care. This study identified the level of use of malaria rapid diagnostic testing (RDT), compliance with test results and associated challenges in the formal private health facilities in Nigeria.
  
  
  METHODS
  A cross-sectional study that involved a multi-stage, random sampling of 240 formal private health facilities from the country's six geo-political zones was conducted from July to August 2014. Data were collected using health facility records, healthcare workers' interviews and an exit survey of febrile patients seen at the facilities, in order to determine fever prevalence, level of testing of febrile patience, compliance with test results, and health workers' perceptions to RDT use.
  
  
  RESULTS
  Data from the 201 health facilities analysed indicated a fever prevalence of 38.5% (112,521/292,430). Of the 2077 exit interviews for febrile patients, malaria testing was ordered in 73.8% (95% CI 71.7-75.7%). Among the 1270 tested, 61.8% (719/1270) were tested with microscopy and 38.2% (445/1270) with RDT. Compliance to malaria test result [administering arteminisin-based combination therapy (ACT) to positive patients and withholding ACT from negative patients] was 80.9% (95% CI 78.7-83%). Compliance was not influenced by the age of patients or type of malaria test. The health facilities have various cadres of the health workers knowledgeable on RDT with 70% knowing the meaning, while 84.5% knew what it assesses. However, there was clearly a preference for microscopy as only 20% reported performing only RDT.
  
  
  CONCLUSIONS
  In formal private health facilities in Nigeria there is a high rate of malaria testing for febrile patients, high level of compliance with test results but relatively low level of RDT utilization. This calls for improved engagement of the formal private health sector with a view to achieving universal coverage targets on malaria testing.
authors.affiliation: Department of Paediatrics and Child Health, College of Health Sciences, University of Ilorin, Ilorin, Kwara, Nigeria. mokuolu@unilorin.edu.ng.
authors.forename: Olugbenga A
authors.initials: OA
authors.lastname: Mokuolu
authors.affiliation: National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria. ntadomg@yahoo.com.
authors.forename: Godwin N
authors.initials: GN
authors.lastname: Ntadom
authors.affiliation: National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria. femiajumobi@gmail.com.
authors.forename: Olufemi O
authors.initials: OO
authors.lastname: Ajumobi
authors.affiliation: University of Lagos, Lagos, Nigeria. aaroberts@cmul.edu.ng.
authors.forename: Roberts A
authors.initials: RA
authors.lastname: Alero
authors.affiliation: Ahmadu Bello University, Zaria, Nigeria. wammanda@yahoo.com.
authors.forename: Robinson D
authors.initials: RD
authors.lastname: Wammanda
authors.affiliation: Department of Paediatrics and Child Health, College of Health Sciences, University of Ilorin, Ilorin, Kwara, Nigeria. ooadedoyin@yahoo.com.
authors.forename: Olanrewaju T
authors.initials: OT
authors.lastname: Adedoyin
authors.affiliation: University of Nigeria, Enugu, Nigeria. huche57@yahoo.com.
authors.forename: Henrietta U
authors.initials: HU
authors.lastname: Okafor
authors.affiliation: Olabisi Onabanjo University, Sagamu, Nigeria. drkalabi@yahoo.com.
authors.forename: Adekunle D
authors.initials: AD
authors.lastname: Alabi
authors.affiliation: University of Calabar, Calabar, Nigeria. faodey@unical.edu.ng.
authors.forename: Friday A
authors.initials: FA
authors.lastname: Odey
authors.affiliation: Nigeria Institute of Medical Research, Lagos, Nigeria. agomoco@hotmail.com.
authors.forename: Chimere O
authors.initials: CO
authors.lastname: Agomo
authors.affiliation: Foundation for Charity and Community Health Nigeria, Abuja, Nigeria. tarus740@yahoo.co.uk.
authors.forename: Kate U
authors.initials: KU
authors.lastname: Edozieh
authors.affiliation: National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria. teejones1605@gmail.com.
authors.forename: Tolulope O
authors.initials: TO
authors.lastname: Fagbemi
authors.affiliation: National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria. ahmadmnrufai@yahoo.com.
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Njidda
authors.affiliation: World Health Organization, Abuja, Nigeria. babatundeo@who.int.
authors.forename: Seye
authors.initials: S
authors.lastname: Babatunde
authors.affiliation: National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria. slimshevy02@yahoo.com.
authors.forename: Emmanuel C
authors.initials: EC
authors.lastname: Agbo
authors.affiliation: National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria. ndyblaise@yahoo.com.
authors.forename: Nnamdi B
authors.initials: NB
authors.lastname: Nwaneri
authors.affiliation: National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria. saintsheka@yahoo.co.uk.
authors.forename: Emmanuel D
authors.initials: ED
authors.lastname: Shekarau
authors.affiliation: Department of Paediatrics and Child Health, College of Health Sciences, University of Ilorin, Ilorin, Kwara, Nigeria. drtopeobasa@gmail.com.
authors.forename: Temitope O
authors.initials: TO
authors.lastname: Obasa
authors.affiliation: National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria. drninaezeigwe@gmail.com.
authors.forename: Nnenna M
authors.initials: NM
authors.lastname: Ezeigwe
mesh_terms: D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000592:standards*; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data; D006801:Humans; D008288:Malaria / Q000175:diagnosis*; D008297:Male; D009549:Nigeria