Assessing the impact of introducing rapid diagnostic testing on malaria case detection at retail pharmacies in Ghana
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Date
2018-11
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KNUST
Abstract
ABSTRACT
Background
In 2010, the World Health Organization issued a guideline that called for a shift from
presumptive malaria treatment to test-based treatment. However, test-based treatment is
still unpopular in a number of community pharmacies in Ghana. The purpose of this study
was to assess the use of malaria rapid diagnostic testing in the management of suspected
malaria cases at retail pharmacies in Ghana.
Methods
This study was done in 3 phases. The first was exploratory baseline study, in which a
questionnaire was used to interview patients exiting on mode of diagnosis to establish the
malaria diagnostic practices, understanding of the treatment and satisfaction of health care
services. An interview also with retail pharmacists to assess their acceptance of mRDTs at
their facilities.
The second was an intervention study evaluating mRDTs (intervention) and PD (control)
at retail pharmacies, and assessing pharmacists’ level of adherence to test results.
The third phase was assessing the cost-benefit of mRDTs at private retail pharmacies using
Willingness-To-Pay payment technique and direct and indirect cost approach.
Results
Most of the practitioners diagnosed malaria presumptively (83.0%, n = 44) as against
(17.0%, n = 9). About 50% of pharmacists agreed to implement mRDTs. Sensitivity and
specificity of the mRDTs were 90.68 + 11.18% and 98.68 + 1.19%, respectively. The
Positive Predictive Value and Negative Predictive Value were both 98.0%; and false
discovery rate, and false omission rate, were both 2.0%. Patients tested negative with
iv
mRDTs, 212 (62.0%) received ACTs. The benefit- cost ratio obtained for using mRDTs
was 1.11.
Conclusions
Malaria diagnosis is largely presumptive. Generally, the patients have shown good
understanding of treatment and satisfaction of health care services received. However, an
indication to implement test-based diagnosis by pharmacist has been expressed, in spite of
not routinely using diagnostic results. The performance of mRDTs in private retail
pharmacies has shown much better accuracy than presumptive diagnosis in detecting
malaria illness. Treatment based on tests result was not properly adhered to, and the cost
benefit analysis of using mRDT was shown to be beneficial with much better economic
value.
Description
A Thesis submitted to the Department of Pharmacy Practice Faculty of Pharmacy and Pharmaceutical Sciences College of Health Sciences in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY