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Abstract：
BACKGROUND: The recommendation of universal diagnostic testing before malaria treatment aimed to address the problem of over-treatment with artemisinin-based combination therapy and the heightened risk of selection pressure and drug resistance and the use of malaria rapid diagnostic test (MRDT) was a key strategy, particularly among primary healthcare (PHC) workers whose access to and use of other forms of diagnostic testing were virtually absent. However, the use of MRDT can only remedy over-treatment when health workers respond appropriately to negative MRDT results by not prescribing anti-malarial drugs. This study assessed the use of MRDT and anti-malarial drug prescription practices, and the predictors, among PHC workers in Ebonyi state, Nigeria.
METHODS: We conducted an analytical cross-sectional questionnaire survey, among consenting PHC workers involved in the diagnosis and treatment of malaria, from January 15, 2020 to February 5, 2020. Data was collected via structured self-administered questionnaire and analysed using descriptive statistics and bivariate and multivariate generalized estimating equations.
RESULTS: Of the 490 participants surveyed: 81.4% usually/routinely used MRDT for malaria diagnosis and 18.6% usually used only clinical symptoms; 78.0% used MRDT for malaria diagnosis for all/most of their patients suspected of having malaria in the preceding month while 22.0% used MRDT for none/few/some; 74.9% had good anti-malarial drug prescription practice; and 68.0% reported appropriate response to negative MRDT results (never/rarely prescribed anti-malarial drugs for the patients) while 32.0% reported inappropriate response (sometimes/often/always prescribed anti-malarial drugs). The identified predictor(s): of the use of MRDT was working in health facilities supported by the United States\' President\'s Malaria Initiative (PMI-supported health facilities); of good anti-malarial drug prescription practice were having good opinion about MRDT, having good knowledge about malaria diagnosis and MRDT, being a health attendant, working in PMI-supported health facilities, and increase in age; and of appropriate response to negative MRDT results was having good opinion about MRDT.
CONCLUSIONS: The evidence indicate the need for, and highlight factors to be considered by, further policy actions and interventions for optimal use of MRDT and anti-malarial drug prescription practices among the PHC workers in Ebonyi state, Nigeria, and similar settings.
METHODS: We conducted an analytical cross-sectional questionnaire survey, among consenting PHC workers involved in the diagnosis and treatment of malaria, from January 15, 2020 to February 5, 2020. Data was collected via structured self-administered questionnaire and analysed using descriptive statistics and bivariate and multivariate generalized estimating equations.
RESULTS: Of the 490 participants surveyed: 81.4% usually/routinely used MRDT for malaria diagnosis and 18.6% usually used only clinical symptoms; 78.0% used MRDT for malaria diagnosis for all/most of their patients suspected of having malaria in the preceding month while 22.0% used MRDT for none/few/some; 74.9% had good anti-malarial drug prescription practice; and 68.0% reported appropriate response to negative MRDT results (never/rarely prescribed anti-malarial drugs for the patients) while 32.0% reported inappropriate response (sometimes/often/always prescribed anti-malarial drugs). The identified predictor(s): of the use of MRDT was working in health facilities supported by the United States\' President\'s Malaria Initiative (PMI-supported health facilities); of good anti-malarial drug prescription practice were having good opinion about MRDT, having good knowledge about malaria diagnosis and MRDT, being a health attendant, working in PMI-supported health facilities, and increase in age; and of appropriate response to negative MRDT results was having good opinion about MRDT.
CONCLUSIONS: The evidence indicate the need for, and highlight factors to be considered by, further policy actions and interventions for optimal use of MRDT and anti-malarial drug prescription practices among the PHC workers in Ebonyi state, Nigeria, and similar settings.
摘要：
背景：建议在疟疾治疗前进行普遍诊断测试，以解决青蒿素为基础的联合疗法过度治疗以及选择压力和耐药性风险增加的问题，并且使用疟疾快速诊断测试（MRDT）是一项关键策略，尤其是在初级卫生保健(PHC)工作者中,他们几乎没有获得和使用其他形式的诊断测试.然而,只有当卫生工作者对MRDT阴性结果没有处方抗疟疾药物做出适当反应时,MRDT的使用才能纠正过度治疗.这项研究评估了MRDT和抗疟疾药物处方的使用，和预测因子，在Ebonyi州的PHC工人中，尼日利亚。
方法：我们进行了分析性横断面问卷调查，在参与疟疾诊断和治疗的PHC工作者中，从2020年1月15日至2020年2月5日。通过结构化的自我管理问卷收集数据，并使用描述性统计以及双变量和多变量广义估计方程进行分析。
结果：在接受调查的490名参与者中：81.4％的人通常/常规使用MRDT进行疟疾诊断，18.6％的人通常仅使用临床症状；78.0％的人使用MRDT对所有/大多数怀疑患有疟疾的患者进行疟疾诊断，而22.0％的人使用MRDT对无/少数/某些患者使用MRDT；74.9％的抗疟疾药物处方效果良好/不确定的预测指标：MRDT的使用在美国总统疟疾倡议（PMI支持的医疗机构）支持的医疗机构中工作；良好的抗疟疾药物处方实践对MRDT有很好的看法，对疟疾诊断和MRDT有很好的了解，作为一名健康服务员，在PMI支持的医疗机构工作，和年龄的增加；对MRDT阴性结果的适当反应对MRDT有很好的评价。
结论：证据表明，并强调要考虑的因素，在Ebonyi州的PHC工作人员中，为最佳使用MRDT和抗疟疾药物处方实践采取进一步的政策行动和干预措施，尼日利亚,和类似的设置。
方法：我们进行了分析性横断面问卷调查，在参与疟疾诊断和治疗的PHC工作者中，从2020年1月15日至2020年2月5日。通过结构化的自我管理问卷收集数据，并使用描述性统计以及双变量和多变量广义估计方程进行分析。
结果：在接受调查的490名参与者中：81.4％的人通常/常规使用MRDT进行疟疾诊断，18.6％的人通常仅使用临床症状；78.0％的人使用MRDT对所有/大多数怀疑患有疟疾的患者进行疟疾诊断，而22.0％的人使用MRDT对无/少数/某些患者使用MRDT；74.9％的抗疟疾药物处方效果良好/不确定的预测指标：MRDT的使用在美国总统疟疾倡议（PMI支持的医疗机构）支持的医疗机构中工作；良好的抗疟疾药物处方实践对MRDT有很好的看法，对疟疾诊断和MRDT有很好的了解，作为一名健康服务员，在PMI支持的医疗机构工作，和年龄的增加；对MRDT阴性结果的适当反应对MRDT有很好的评价。
结论：证据表明，并强调要考虑的因素，在Ebonyi州的PHC工作人员中，为最佳使用MRDT和抗疟疾药物处方实践采取进一步的政策行动和干预措施，尼日利亚,和类似的设置。
