MWJ 2014, 5, 2
It has been recommended that the use of ACTs is restricted to only those with confirmed positive malaria diagnosis. The potential benefits of rapid diagnostic tests (RDTs) on anti-malarial drug consumption have been demonstrated in a number of clinical trials. ACT prescribing patterns for febrile patients were compared pre- and post-RDT introduction in 106 Nigerian primary health care facilities. Routine data from the national malaria control programme monthly facility summary forms were extracted for three months before and after the RDT intervention and compared using a ‘before and after’ design. RDT testing rates for patients with fever revealed no trend; mean testing rate in the post RDT period was 64.5%. The mean malaria positivity rate was 71.3%, which equalled a proportional morbidity rate of 45.9% of all fever cases. ACT treatment to confirmed case ratio was consistently above the expected value of one and the ratio of treatment to tested patient exceeded one (mean ratio of 1.1) for the three months post RDT. The absolute number of ACT doses prescribed increased remarkably after the introduction of RDTs. There is notable non-adherence to RDT results, with an increase in ACT prescriptions after the initial introductory period for RDTs. This over reliance on ACTs for the management of non-malaria illness could compromise gains from reducing malaria morbidity and mortality and needs to be addressed urgently.