Context
The Malaria Rapid Diagnostic Test Capture and Reporting Assessment (MaCRA) project was initiated to address critical challenges related to the accuracy and reliability of malaria Rapid Diagnostic Tests (RDTs) in peripheral health facilities. Inconsistent interpretation, use, recording, and reporting of RDT results at primary healthcare facilities hindered the accurate diagnosis and treatment of malaria, particularly in Nigeria and other participating countries. The project’s objective was to assess these issues and provide data-driven insights to enhance malaria diagnosis accuracy, aiming to strengthen malaria control efforts across multiple countries, with funding from the U.S. President’s Malaria Initiative (PMI) and collaboration with PATH.
Action
The MaCRA project was executed in 16 primary healthcare facilities across Sokoto and Oyo states in Nigeria, ensuring coverage of both northern and southern regions. The facilities were also split into urban and rural as well as into and experimental and a control group. Over a 16-month period, the project assessed the level of agreement between RDT results recorded in health facility registers and those assessed by an independent expert panel. It focused on identifying factors contributing to disparities in RDT interpretation and evaluating the impact of the project’s presence on malaria test positivity rates.
Key activities included:
• Data Collection: Both qualitative and quantitative methods were used to gather data on healthcare workers’ (HCWs) training, knowledge, experience, and behaviours regarding malaria RDTs, as well as health system factors influencing RDT use.
• Country Collaboration: Standardized data collection tools were developed and configured by Sydani for use in multiple participating countries, including Benin, Côte d’Ivoire, and Uganda. These tools ensured consistency and quality in the assessment process across diverse settings.
• Supervisory Visits.
• Expert Review: An independent expert panel reviewed the RDT results, comparing them with the HCW interpretations to assess the accuracy of diagnosis and reporting.
Result
The project successfully demonstrated a high level of agreement between the RDT results interpreted by healthcare workers and those of the independent expert panel, with a kappa score of 0.8, indicating a strong correlation. This suggests that HCWs in the studied facilities were largely accurate in their interpretation of RDT results, reflecting the positive impact of the training provided and adherence to diagnostic protocols.
Additionally, the state-of-the-art data collection and reporting mechanisms recommended through the project contributed to improved malaria data accuracy across the participating countries.
This success underscored the importance of continuous training and the use of standardized data collection tools, not only in Nigeria but also across other participating countries, further bolstering the accuracy of malaria diagnosis and reporting systems.
