What challenges did primary care facilities face in using malaria rapid tests?

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Malaria rapid diagnostic tests (RDTs) are relatively simple to perform and provide quick results for treatment decisions. However, the accuracy and use of their results depend on factors including test quality, storage, transport and end-user performance.

Researchers conducted a cross-sectional survey to explore factors affecting RDT performance and use in primary care facilities in South Africa. The study took place in three malaria-risk sub-districts of Limpopo Province, South Africa. Using semi-structured questionnaires, the researchers interviewed 20 nurses randomly selected from 17 primary health care facilities, three nurses from hospitals serving the study area, and 10 other key informants representing managers of malaria control programmes and routine and research laboratories.

Ordering and distribution of RDTs were highly efficient, but only 13/20 health facilities (65%) had appropriate air-conditioning and room-temperature monitoring. Twelve of 20 nurses (60%) had received no external training on performing and interpreting RDTs. Ten of 20 nurses (50%) reported RDT stock-outs. Only 3/20 nurses said they periodically checked RDT quality. Fifteen percent of nurses reported giving antimalarial drugs even when the RDT result was negative.

The researchers concluded that storage, quality assurance, end-user training and the use of RDT results for clinical decisions in South African primary care facilities need improvement. They called for further studies of factors influencing RDT quality control and performance, and ways to improve RDT use.