Author:
- Introduction
- Materials and Methods
- Results
- Description of the study population.
- Background characteristics of LCSA and clients.
- Presentations of complaints and use of antimalarials before visiting LCS.
- Licensed chemical shop attendants assessment of clients’ vitals and danger signs.
- Accuracy of TbMM at LCS.
- Outcome of treatment at LCS.
- Referral of clients.
- Discussion
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
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The Accuracy and Perception of Test-Based Management of Malaria at Private Licensed Chemical Shops in the Middle Belt of Ghana
Anthony Kwarteng
Anthony Kwarteng
Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana;
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Keziah L. Malm
Keziah L. Malm
The National Malaria Control Program, Ghana Health Service, Accra, Ghana;
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Lawrence Gyabaa Febir
Lawrence Gyabaa Febir
Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana;
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Theresa Tawiah
Theresa Tawiah
Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana;
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George Adjei
George Adjei
Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana;
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Solomon Nyame
Solomon Nyame
Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana;
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Francis Agbokey
Francis Agbokey
Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana;
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Mieks Twumasi
Mieks Twumasi
Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana;
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Seeba Amenga-Etego
Seeba Amenga-Etego
Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana;
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Daniel Amaning Danquah
Daniel Amaning Danquah
The National Malaria Control Program, Ghana Health Service, Accra, Ghana;
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Constance Bart-Plange
Constance Bart-Plange
The Pharmacy Council of Ghana, Ministry of Health, Accra, Ghana;
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Seth Owusu-Agyei
Seth Owusu-Agyei
Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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Kwaku Poku Asante
Kwaku Poku Asante
Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana;
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The sale of artemisinin-based combination therapy (ACT) by private licensed chemical shops (LCS) without testing is contrary to current policy recommendations. This study assessed the accuracy and perception of test-based management of malaria using malaria rapid diagnostic test (mRDT) kits at private LCS in two predominantly rural areas in the middle part of Ghana. Clients presenting at LCS with fever or other signs and symptoms suspected to be malaria in the absence of signs of severe malaria were tested with mRDT by trained attendants and treated based on the national malaria treatment guidelines. Using structured questionnaires, exit interviews were conducted within 48 hours and a follow-up interview on day 7 (±3 days). Focus group discussions and in-depth interviews were also conducted to assess stakeholders’ perception on the use of mRDT at LCS. About 79.0% (N = 1,797) of clients reported with a fever. Sixty-six percent (947/1,426) of febrile clients had a positive mRDT result. Eighty-six percent (815/947) of clients with uncomplicated malaria were treated with the recommended ACT. About 97.8% (790/808) of clients with uncomplicated malaria treated with ACT were reported to be well by day 7. However, referral for those with negative mRDT results was very low (4.1%, 27/662). A high proportion of clients with a positive mRDT result received the recommended malaria treatment. Test-based management of malaria by LCS attendants was found to be feasible and acceptable by the community members and other stakeholders. Successful implementation will however require effective referral, supervision and quality control systems.
Author Notes
Financial support: The study was funded by the Global Fund through the Ghana National Malaria Control Program of the Ghana Health Service.
Authors’ addresses: Anthony Kwarteng, Lawrence Gyabaa Febir, Theresa Tawiah, George Adjei, Solomon Nyame, Francis Agbokey, Mieks Twumasi, Seeba Amenga-Etego, and Kwaku Poku Asante, Kintampo Health Research Center (KHRC), Ghana Health Service, Kintampo, Ghana, E-mails: anthony.kwarteng@kintampo-hrc.org, lawrence.febir@kintampo-hrc.org, theresa.tawiah@kintampo-hrc.org, george.adjei@kintampo-hrc.org, solomon.nyame@kintampo-hrc.org, francis.agbokey@kintampo-hrc.org, mieks.twumasi@kintampo-hrc.org, seeba.ae@kintampo-hrc.org, and kwakupoku.asante@kintampo-hrc.org. Keziah L. Malm and Constance Bart-Plange, The National Malaria Control Program, Ghana Health Service, Accra, Ghana, E-mails: keziah.malm@ghsmail.org and constance.bartplange@ghsmail.org. Daniel Amaning Danquah, The Pharmacy Council of Ghana, Ministry of Health, Accra, Ghana, E-mail: dandanquah45@gmail.com. Seth Owusu-Agyei, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana, E-mail: sowusuagyei@uhas.edu.gh.
- Introduction
- Materials and Methods
- Results
- Description of the study population.
- Background characteristics of LCSA and clients.
- Presentations of complaints and use of antimalarials before visiting LCS.
- Licensed chemical shop attendants assessment of clients’ vitals and danger signs.
- Accuracy of TbMM at LCS.
- Outcome of treatment at LCS.
- Referral of clients.
- Discussion
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
World Health Organization, 2016. World Malaria Report 2016. Geneva, Switzerland: WHO. Available at: http://www.who.int/malaria/publications/world-malaria-report-2016/report/en/. Accessed February 4, 2017.
-
2.
Schellenberg JA, Victora CG, Mushi A, de Savigny D, Schellenberg D, Mshinda H & Bryce J Tanzania Integrated Management of Childhood Illness MCE Baseline Household Survey Study Group, 2003. Inequities among the very poor: health care for children in rural southern Tanzania. Lancet 361: 561–566.
-
3.
Sulemana A, Dinye RD, 2014. Access to healthcare in rural communities in Ghana: a study of some selected communities in the Pru district. Eur J Res Soc Sci 2: 122–132.
-
4.
Ministry of Health, 2013. Health Professions Regulatory Bodies Act, 2013. (Act 857). Accra, Ghana: Government of Ghana.
-
5.
Asante KP et al. 2010. Community perceptions of malaria and malaria treatment behaviour in a rural district of Ghana: implications for artemisinin combination therapy. BMC Public Health 10: 409.
-
6.
Tawiah T, Asante KP, Dwommoh RA, Kwarteng A, Gyaase S, Mahama E, Abokyi L, Amenga-Etego S, Hansen K, Akweongo P, 2016. Economic costs of fever to households in the middle belt of Ghana. Malar J 15: 68.
-
7.
Alba S, Hetzel MW, Goodman C, Dillip A, Liana J, Mshinda H, Lengeler C, 2010. Improvements in access to malaria treatment in Tanzania after switch to artemisinin combination therapy and the introduction of accredited drug dispensing outlets-a provider perspective. Malar J 9: 164.
-
8.
Wafula FN, Miriti EM, Goodman CA, 2012. Examining characteristics, knowledge and regulatory practices of specialized drug shops in Sub-Saharan Africa: a systematic review of the literature. BMC Health Serv Res 12: 223.
-
9.
Lowe RF, Montagu D, 2009. Legislation, regulation, and consolidation in the retail pharmacy sector in low-income countries. South Med Rev 2: 35–44.
-
10.
Ministry of Health, 2014. Guidelines for Case Management of Malaria in Ghana, 3rd edition. Accra, Ghana: Ministry of Health.
-
11.
World Health Organization, 2009. Parasitological Confirmation of Malaria Diagnosis. Report of Technical Consultation. Geneva, Switzerland: WHO. Available at: http://whqlibdoc.who.int/publications/2010/9789241599412_eng.pdf. Accessed February 14, 2017.
-
12.
World Health Organization, 2015. Guidelines for Treatment of Malaria, 3rd edition. Geneva, Switzerland: WHO. Available at: http://www.who.int/malaria/publications/atoz/9789241549127/en/. Accessed February 14, 2017.
-
13.
Msellem MI, Mårtensson A, Rotllant G, Bhattarai A, Strömberg J, Kahigwa E, Garcia M, Petzold M, Olumese P, Ali A, 2009. Influence of rapid malaria diagnostic tests on treatment and health outcome in fever patients, Zanzibar—a crossover validation study. PLoS Med 6: e1000070.
-
14.
Shillcutt S, Morel C, Goodman C, Coleman P, Bell D, Whitty CJ, Mills A, 2008. Cost-effectiveness of malaria diagnostic methods in Sub-Saharan Africa in an era of combination therapy. Bull World Health Organ 86: 101–110.
-
15.
Yukich J, D’Acremont V, Kahama J, Swai N, Lengeler C, 2010. Cost savings with rapid diagnostic tests for malaria in low-transmission areas: evidence from Dar es Salaam, Tanzania. Am J Trop Med Hyg 83: 61–68.
-
16.
Dalinjong PA, Welaga P, Akazili J, Kwarteng A, Bangha M, Oduro A, Sankoh O, Goudge J, 2017. The association between health insurance status and utilization of health services in rural northern Ghana: evidence from the introduction of the national health insurance scheme. J Health Popul Nutr 36: 42.
-
17.
Danquah DA, Buabeng KO, Asante KP, Mahama E, Bart-Plange C, Owusu-Dabo E, 2016. Malaria case detection using rapid diagnostic test at the community level in Ghana: consumer perception and practitioners’ experiences. Malar J 15: 34.
-
18.
Mbonye AK, Ndyomugyenyi R, Turinde A, Magnussen P, Clarke S, Chandler C, 2010. The feasibility of introducing rapid diagnostic tests for malaria in drug shops in Uganda. Malar J 9: 367.
-
19.
Reda H, 2012. Improving Efficiency, Access to and Quality of the Rural Health Extension Programme in Tigray, Ethiopia: the Case of Malaria Diagnosis and Treatment. Medical Dissertations, New Series, Umeå University, Sweden.
-
20.
Thiam S, Thwing J, Diallo I, Fall FB, Diouf MB, Perry R, Ndiop M, Diouf ML, Cisse MM, Diaw MM, 2012. Scale-up of home-based management of malaria based on rapid diagnostic tests and artemisinin-based combination therapy in a resource-poor country: results in Senegal. Malar J 11: 334.
-
21.
Mayxay M, Newton PN, Yeung S, Pongvongsa T, Phompida S, Phetsouvanh R, White NJ, 2004. An assessment of the use of malaria rapid tests by village health volunteers in rural Laos. Trop Med Int Health 9: 325–329.
-
22.
D'Acremont V, Lengeler C, Mshinda H, Mtasiwa D, Tanner M, Genton B, 2009. Time to move from presumptive malaria treatment to laboratory-confirmed diagnosis and treatment in African children with fever. PLoS Med 6: e252.
-
23.
Owusu-Agyei S, Ernest A, Nettey O, Zandoh C, Sulemana A, Adda R, Amenga-Etego S, Mbacke C, 2012. Demographic patterns and trends in central Ghana: baseline indicators from the Kintampo health and demographic surveillance system. Glob Health Action 5: 19033.
-
24.
Dery DB, Brown C, Asante KP, Adams M, Dosoo D, Amenga-Etego S, Wilson M, Chandramohan D, Greenwood B, Owusu-Agyei S, 2010. Patterns and seasonality of malaria transmission in the forest-savannah transitional zones of Ghana. Malar J 9: 314.
-
25.
Owusu-Agyei S et al. 2009. Epidemiology of malaria in the forest-savanna transitional zone of Ghana. Malar J 8: 220.
-
26.
Ministry of Health, 2009. Guidelines for Case Management of Malaria in Ghana, 2nd edition. Accra, Ghana: Ministry of Health.
-
27.
Kwarteng A, Asante KP, Abokyi L, Gyaase S, Febir LG, Mahama E, Konadu DG, Tawiah T, Adu-Gyasi D, Dosoo D, 2015. Provider compliance to artemisinin-based combination therapy at primary health care facilities in the middle belt of Ghana. Malar J 14: 361.
-
28.
Thiam S, Thior M, Faye B, Ndiop M, Diouf ML, Diouf MB, Diallo I, Fall FB, Ndiaye JL, Albertini A, 2011. Major reduction in anti-malarial drug consumption in Senegal after nation-wide introduction of malaria rapid diagnostic tests. PLoS One 6: e18419.
-
29.
Elmardi KA, Malik EM, Abdelgadir T, Ali SH, Elsyed AH, Mudather MA, Elhassan AH, Adam I, 2009. Feasibility and acceptability of home-based management of malaria strategy adapted to Sudan’s conditions using artemisinin-based combination therapy and rapid diagnostic test. Malar J 8: 39.
-
30.
Yeboah-Antwi K, Pilingana P, Macleod WB, Semrau K, Siazeele K, Kalesha P, Hamainza B, Seidenberg P, Mazimba A, Sabin L, 2010. Community case management of fever due to malaria and pneumonia in children under five in Zambia: a cluster randomized controlled trial. PLoS Med 7: 1139.
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