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Training health workers to improve malaria diagnosis in Cameroon and Nigeria (Policy Brief)


REACT Policy Brief

Category: Intervention Manuals

Sub Category: Method Guidance

Author: Virginia Wiseman, Wilfred Mbacham, Obi Onwujekwe

Published Date: 05 June 2016




The World Health Organization (WHO) recommends that patients are tested for malaria before receiving antimalarial treatment, but many health workers still diagnose patients based on their signs and symptoms alone. This often results in malaria overdiagnosis and overtreatment.

Researchers from the REACT studies in Cameroon and Nigeria evaluated different types of health worker training and community education interventions to address this problem of overdiagnosis and support the effective scale-up of rapid diagnostic tests (RDTs) for malaria.

In Cameroon, we found that the training led to a decrease in malaria overdiagnosis, preventing the wastage of artemisinin-based combination therapy (ACT), the recommended treatment for malaria. In contrast, the training interventions in Nigeria did little to change behaviour. The levels of malaria testing remained very low and health workers were still wasting expensive malaria drugs on patients who did not need them.

The challenges of designing and implementing effective behaviour change interventions to support the roll-out of malaria testing should not be under-estimated. Many studies have investigated the performance of RDTs in ideal settings. With this research we aimed to see how our interventions influenced behaviours, according to the different types of health services and context. Our studies show that, in order to improve the targeting of malaria medicines, governments need to focus more on changing behaviour of health workers as well as the expectations of patients and their families.



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