Improving Access to Malaria Rapid Diagnostic Test in Niger State Nigeria : An Assessment of Implementation Up to 2013

Background: Nigeria adopted the WHO diagnosis and treatment guidelines within the framework of its 2009-2013 strategic plan, which included the use of Rapid Diagnostic Tests (RDTs) prior to prescribing malaria treatment with Artemisinin Combination Therapy (ACTs). This study explores accessibility barriers to the use of Malaria RDTs in Niger State, and formulates recommendations for improving the uptake of RDTs. Methods: Three strategies were adopted: 1) Literature review (both published and grey literature); 2) Review of data from the Niger State Health Management Information System for the period January-October 2013; 3) Application of a conceptual framework (Peters et al. 2008) for assessing access to health services. Results: Only 27 percent of public health facilities (HFs) implemented RDTs with the aid of donor funds. 77 percent of all fever cases presented in these HFs during January-October 2013 were tested with RDTs; 53 percent of all fever cases were confirmed cases of malaria; while 60 percent of all fever cases were treated. In 2013, 871,702 of ACTs were supplied as against 332,466 of RDTs. Private-sector presumptive treatments of malaria outnumber HFs treatment on the basis of RDT confirmation. Stockout of RDTs is the major constraint, and severe fever tends to trigger presumptive treatment. Conclusions: Implementation of RDTs led to a reduction in the use of ACTs at HFs. However, more substantial ACTs reduction could be achieved if the State Government directed more resources towards the acquisition of RDTs. Additionally, accessibility of RDTs is linked to the level of awareness of potential users about the service and its availability