The private sector market for malaria rapid diagnostic tests in Nigeria: results of the 2018 market survey

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

To avoid misuse of anti-malarials, correct diagnosis of fever prior to drug prescription is essential. Presumptive treatment in the private healthcare sector is a concern in Nigeria, where availability of affordable artemisinin-based combination therapy (ACT) is high following the implementation of subsidy schemes from 2010 to 2017. Similar subsidies have not, however, been implemented for malaria rapid diagnostic tests (RDTs). A market survey in 2018 predominantly designed to assess the ACT market in the private sector also collected data related to RDTs, results of which are presented herein.

Methods

A 2018 market survey consisted of (i) an outlet survey targeting private pharmacies and Proprietary and Patent Medicine Vendors (PPMVs) across different regions of Nigeria to assess supply-side market factors related to availability of RDTs (defined as having stock available for purchase at the time of the survey) and (ii) a household survey to determine demand-side factors related to knowledge of RDTs, healthcare-seeking practices and affordability.

Results

Availability of RDTs at the time of the survey was low in both outlet types and significantly lower in PPMVs (22.1%, 95% CI) among pharmacies versus (13.6%, 95% CI) among PPMVs (p < 0.01). Reasons for not restocking RDTs included low demand and no supply. The majority of households diagnose malaria based on experience, while one-third would visit a PPMV or pharmacy. Half of households had heard of RDTs (48.4%) and 38.6% thought they were affordable.

Conclusions

Low availability of RDTs among PPMVs and pharmacies may be attributed to lack of demand, supply-side issues and cost. Increasing household knowledge of RDTs may aid increasing demand, while subsidized RDTs may address supply and price issues. Addressing the deficit in RDT provision is important for targeting of ACT medicines.

Related collections

Most cited references 22

Record: found
Abstract: found
Article: found

Is Open Access

Rapid testing for malaria in settings where microscopy is available and peripheral clinics where only presumptive treatment is available: a randomised controlled trial in Ghana

Evelyn Ansah, Solomon Narh-Bana, Michael Epokor … (2010)

Objective To test in West Africa the impact of rapid diagnostic tests on the prescription of antimalarials and antibiotics both where microscopy is used for the diagnosis of malaria and in clinical (peripheral) settings that rely on clinical diagnosis. Design Randomised, controlled, open label clinical trial. Setting Four clinics in the rural Dangme West district of southern Ghana, one in which microscopy is used for diagnosis of malaria (“microscopy setting”) and three where microscopy is not available and diagnosis of malaria is made on the basis of clinical symptoms (“clinical setting”). Participants Patients with suspected malaria. Interventions Patients were randomly assigned to either a rapid diagnostic test or the current diagnostic method at the clinic (microscopy or clinical diagnosis). A blood sample for a research microscopy slide was taken for all patients. Main outcome measures The primary outcome was the prescription of antimalarials to patients of any age whose double read research slide was negative for malaria. The major secondary outcomes were the correct prescription of antimalarials, the impact of test results on antibiotic prescription, and the correct prescription of antimalarials in children under 5 years. Results Of the 9236 patients screened, 3452 were randomised in the clinical setting and 3811 in the microscopy setting. Follow-up to 28 days was 97.6% (7088/7263). In the microscopy setting, 722 (51.6%) of the 1400 patients with negative research slides in the rapid diagnostic test arm were treated for malaria compared with 764 (55.0%) of the 1389 patients in the microscopy arm (adjusted odds ratio 0.87, 95% CI 0.71 to 1.1; P=0.16). In the clinical setting, 578 (53.9%) of the 1072 patients in the rapid diagnostic test arm with negative research slides were treated for malaria compared with 982 (90.1%) of the 1090 patients with negative slides in the clinical diagnosis arm (odds ratio 0.12, 95% CI 0.04 to 0.38; P=0.001). The use of rapid diagnostic tests led to better targeting of antimalarials and antibiotics in the clinical but not the microscopy setting, in both children and adults. There were no deaths in children under 5 years at 28 days follow-up in either arm. Conclusion Where microscopy already exists, introducing rapid diagnostic tests had limited impact on prescriber behaviour. In settings where microscopy was not available, however, using rapid diagnostic tests led to a significant reduction in the overprescription of antimalarials, without any evidence of clinical harm, and to better targeting of antibiotics. Trial registration ClinicalTrials.gov NCT00493922.

0 comments Cited 92 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: not found
Article: not found

A link between poor quality antimalarials and malaria drug resistance?

Paul N. Newton, Céline Caillet, Philippe Guérin (2016)

0 comments Cited 41 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Introducing malaria rapid diagnostic tests in private medicine retail outlets: A systematic literature review

Theodoor Visser, Katia Bruxvoort, Kathleen Maloney … (2017)

Background Many patients with malaria-like symptoms seek treatment in private medicine retail outlets (PMR) that distribute malaria medicines but do not traditionally provide diagnostic services, potentially leading to overtreatment with antimalarial drugs. To achieve universal access to prompt parasite-based diagnosis, many malaria-endemic countries are considering scaling up malaria rapid diagnostic tests (RDTs) in these outlets, an intervention that may require legislative changes and major investments in supporting programs and infrastructures. This review identifies studies that introduced malaria RDTs in PMRs and examines study outcomes and success factors to inform scale up decisions. Methods Published and unpublished studies that introduced malaria RDTs in PMRs were systematically identified and reviewed. Literature published before November 2016 was searched in six electronic databases, and unpublished studies were identified through personal contacts and stakeholder meetings. Outcomes were extracted from publications or provided by principal investigators. Results Six published and six unpublished studies were found. Most studies took place in sub-Saharan Africa and were small-scale pilots of RDT introduction in drug shops or pharmacies. None of the studies assessed large-scale implementation in PMRs. RDT uptake varied widely from 8%-100%. Provision of artemisinin-based combination therapy (ACT) for patients testing positive ranged from 30%-99%, and was more than 85% in five studies. Of those testing negative, provision of antimalarials varied from 2%-83% and was less than 20% in eight studies. Longer provider training, lower RDT retail prices and frequent supervision appeared to have a positive effect on RDT uptake and provider adherence to test results. Performance of RDTs by PMR vendors was generally good, but disposal of medical waste and referral of patients to public facilities were common challenges. Conclusions Expanding services of PMRs to include malaria diagnostic services may hold great promise to improve malaria case management and curb overtreatment with antimalarials. However, doing so will require careful planning, investment and additional research to develop and sustain effective training, supervision, waste-management, referral and surveillance programs beyond the public sector.

0 comments Cited 40 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Hannah M. Edwards:

ORCID: http://orcid.org/0000-0001-8706-0732

hmedwards88@gmail.com

Journal

Journal ID (nlm-ta): Malar J

Journal ID (iso-abbrev): Malar J

Title: Malaria Journal

Publisher: BioMed Central (London )

ISSN (Electronic): 1475-2875

Publication date (Electronic): 16 June 2022

Publication date PMC-release: 16 June 2022

Publication date Collection: 2022

Volume: 21

Electronic Location Identifier: 190

Affiliations

[1 ]GRID grid.475304.1, ISNI 0000 0004 6479 3388, Malaria Consortium Headquarters, ; 244-254 Cambridge Heath Rd, London, E2 9DA UK

[2 ]Innovision Consulting Private Limited, Level 3 & 4 House 26 Road 6 Baridhara J Block Pragati Sarani, Dhaka, 1212 Bangladesh

[3 ]Case Management Branch, National Malaria Elimination Programme, First Floor, Abia House, Central Business District, Abuja, Nigeria

[4 ]Malaria Consortium Nigeria, 33 Pope John Paul Street, Off Gana Street, Maitama, Abuja, FCT Nigeria

Author information

Hannah M. Edwards http://orcid.org/0000-0001-8706-0732

Article

Publisher ID: 4209

DOI: 10.1186/s12936-022-04209-3

PMC ID: 9205121

PubMed ID: 35710474

SO-VID: f8f0c2f5-7cb9-4a92-99fe-0e7cf2a6fbae

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 20 February 2022

Date accepted : 30 May 2022

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000617, Foreign and Commonwealth Office;

Award ID: SuNMaP 2 Accountable Grant

Custom metadata

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: private sector healthcare,case management,diagnostics,health economics,malaria control,informal health workers,private sector engagement,targeted subsidy,private sector co-payment mechanism

Data availability:

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: private sector healthcare, case management, diagnostics, health economics, malaria control, informal health workers, private sector engagement, targeted subsidy, private sector co-payment mechanism

The private sector market for malaria rapid diagnostic tests in Nigeria: results of the 2018 market survey

Read this article at

Abstract

Background

Methods

Results

Conclusions

Related collections

HIV Self-Testing

Most cited references 22

Rapid testing for malaria in settings where microscopy is available and peripheral clinics where only presumptive treatment is available: a randomised controlled trial in Ghana

A link between poor quality antimalarials and malaria drug resistance?

Introducing malaria rapid diagnostic tests in private medicine retail outlets: A systematic literature review

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 25

Cited by 4

Most referenced authors 246