Progress of test-before-treatment guidelines for malaria in Ghana

Anopheles albimanus, a mosquito that transmits malaria (James Gathany, CDC/P Public Health Image Library #7861)

About six years have passed since Ghana initiated the test-before-treatment (TBT) guidelines for malaria. Rapid diagnostic tests (RDTs) have been used for testing malaria at most healthcare centres due to limited resources to conduct microscopy tests. There have been reports that some healthcare practitioners do not implement the TBT and RDT guidelines and patients are still treated without testing or patients who test negative are given malaria treatment.

A qualitative study has found that challenges with the implementation of the TBT and RDT guidelines are due to problems with healthcare delivery (including limited RDT supply and problems with storage); reliance on clinical judgement rather than laboratory tests; cost of RDTs; and limited engagement of healthcare providers in policy processes.

The study, published in the Malaria Journal, used qualitative interviews, focus groups and direct observation of 50 healthcare providers at the Atwima-Nwabiagya District, Ashanti Region.

The study recommended that implementation of the TBT and RDT guidelines can be more effective if providers are: “(1) adequately enabled through efficient allocation and management of essential healthcare commodities; (2) appropriately empowered with the requisite knowledge and skill through ongoing, effective professional development; and (3) actively engaged in policy dialogue to demystify socio-political misconceptions that hinder health sector reform policies from improving care delivery.”

Authors of the study were N.Y. Boadu, D. Menon and S.K. Yanow of the School of Public Health, University of Alberta, Canada; J. Amuasi of Kumasi Collaborative Center for Research in Tropical Medicine, (EOD Group) KNUST, Ghana; D. Ansong of the Research and Development Unit, Komfo Anokye Teaching Hospital, Ghana; E. Einsiedel of Department of Communication and Culture, University of Calgary, Canada.

Read more: Challenges with implementing malaria rapid diagnostic tests at primary care facilities in a Ghanaian district: a qualitative study

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