ABSTRACT
In Nigeria, malaria accounts for 30% mortality in children <5years (U5). World Health Organisation guidelines recommend parasite-based diagnosis prior to commencement of antimalarial treatment. However, empirical treatment remains a common phenomenon at homes and in clinical settings because of presumed high malaria prevalence. This is compounded by inadequate information on accuracy of malaria rapid diagnostic test (RDT). Data on factors affecting the utilisation of malaria laboratory services (MLS) is not readily available. We conducted a study to assess the diagnostic accuracy of Standard Diagnostic (SD) Bioline malaria rapid diagnostic test, and to determine the factors affecting the utilisation of MLS in febrile children in Kaduna State, Northern Nigeria. We conducted a cross-sectional study of 296 caregivers of febrile U5 at Makarfi General Hospital (MGH), Kaduna state from December 2010 to August 2011. We used structured questionnaires to collect data on socio-demographics of caregivers, clinical information on febrile U5, and utilisation of MLS. Blood samples were collected from 296 U5 and examined for malaria parasites with SD Bioline rapid diagnostic test (RDT) and routine microscopy. The diagnostic accuracy of the RDT was determined. Focus group discussions (n=4) were conducted at Makarfi communities to determine the factors affecting utilisation of MLS among caregivers of children U5. Eight key informants were interviewed to determine the capacity for malaria diagnosis at MGH. VII The sensitivity, specificity, negative and positive predictive values of SD Bioline RDT were 100%, 98.5%, 100% and 88.6% respectively. The prevalence of malaria in the febrile children was 10.5% and 11.8% by RDT and microscopy respectively. Plasmodium falciparum infection rate was 100%. Overall, 3.7% of caregivers were offered any malaria laboratory test by health staff and 5.5% have ever heard about MLS. Non-request of MLS by health staff, lack of awareness, presumptive treatment, and long distance from health centre, caregiver's perceived severity of illness, high cost, and non-availability of MLS were responsible for poor utilization of malaria laboratory services. Lack of trained staff, basic reagents for malaria microscopy and quality assurance mechanisms were responsible for poor capacity for malaria diagnosis at MGH. SD Bioline RDT has a high sensitivity and specificity despite low prevalence of malaria. This strongly precludes the current practice of presumptive treatment of fever in U5. SD Bioline RDT should be rapidly deployed to all health facilities where there are no facilities for microscopy. Kaduna state and Makarfi local government should sensitise health care providers on confirmatory malaria diagnosis in children. They should sensitise caregivers in rural communities about utilization of MLS. Equally, they should provide access to MLS at an affordable cost in rural communities and urgently strengthen capacity for MLS. Key words: malaria, sensitivity, laboratory services, rapid diagnostic test, Nigeria.