title: Compliance With Malaria Rapid Diagnostic Testing by Community Health Workers in 3 Malaria-Endemic Countries of Sub-Saharan Africa: An Observational Study.
abstract: BACKGROUND
  The World Health Organization recommends that all malaria management be based on parasitological identification. We monitored performance of trained community health workers (CHWs) in adhering to this recommendation to restrict artemisinin-based combination therapies (ACTs) to positive rapid diagnostic test (RDT)-confirmed cases in children in 3 malaria-endemic sub-Saharan African countries.
  
  
  METHODS
  In 33 villages in Burkina Faso, 45 villages in Nigeria, and 84 villages in Uganda, 265 CHWs were trained over a minimum of 3 days to diagnose malaria using RDTs (prepare, read, record results, and inform the patient about results) and treat RDT-confirmed uncomplicated malaria cases with ACTs. In Nigeria, CHWs were also taught to obtain a thick blood smear. Spent RDT kits and prepared blood slides were collected and interpreted independently in Burkina Faso and Nigeria to confirm CHWs' diagnoses. Interviews were held with 12 of 17 CHWs who prescribed ACTs for patients with RDT-negative test results, and with 16 of 29 caregivers to determine factors related to noncompliance.
  
  
  RESULTS
  Of 12 656 patients treated with ACTs in the participating countries (5365 in Burkina Faso, 1648 in Nigeria, and 5643 in Uganda), 29 patients (8 from Burkina Faso, 17 from Nigeria, 4 from Uganda) were RDT negative. The small number of RDT-negative ACT-treated cases limits statistical analysis. Only a few CHWs were involved, and they were more likely to be traders rather than farmers (odds ratio [OR], 6.15; 95% confidence interval [CI], 2.09-18.07; P = .0004). RDT-negative children who were treated with ACTs had a significantly higher probability of residing in a village other than that of the CHW (OR, 3.85; 95% CI, 1.59-9.30; P = .0018). Parental pressure was identified in interviews with parents.
  
  
  CONCLUSIONS
  Noncompliance with results of RDT tests is relatively rare when CHWs are trained and well supervised.
  
  
  BACKGROUND
  ISRCTN13858170.
authors.affiliation: UNICEF/UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Singlovic
authors.affiliation: Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria.
authors.forename: IkeOluwapo O
authors.initials: IO
authors.lastname: Ajayi
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Jesca
authors.initials: J
authors.lastname: Nsungwa-Sabiiti
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Mohamadou
authors.initials: M
authors.lastname: Siribié
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Armande K
authors.initials: AK
authors.lastname: Sanou
authors.affiliation: Department of Sociology, Faculty of Social Sciences.
authors.forename: Ayodele S
authors.initials: AS
authors.lastname: Jegede
authors.affiliation: Department of Pharmacology and Therapeutics, College of Medicine.
authors.forename: Catherine O
authors.initials: CO
authors.lastname: Falade
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Luc
authors.initials: L
authors.lastname: Sermé
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Zakaria
authors.initials: Z
authors.lastname: Gansane
authors.affiliation: Epidemiology and Biostatistics Research Unit, Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria.
authors.forename: Chinenye
authors.initials: C
authors.lastname: Afonne
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Kabarungi
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Josephine
authors.initials: J
authors.lastname: Kyaligonza
authors.affiliation: Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, The Netherlands.
authors.forename: Joëlle
authors.initials: J
authors.lastname: Castellani
authors.affiliation: Centre for Applied Biostatistics, Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
authors.affiliation: UNICEF/UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Melba
authors.initials: M
authors.lastname: Gomes
mesh_terms: D000285:Administration, Rectal; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use; D037621:Artemisinins / Q000008:administration & dosage / Q000627:therapeutic use; D000077332:Artesunate; D003150:Community Health Workers / Q000706:statistics & numerical data*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006801:Humans; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D010349:Patient Compliance
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D000077332:Artesunate
keywords: ACT; community health worker; compliance to test result; malaria; rapid diagnostic test