Clarification on social group interventions and malaria rapid diagnostic test uptake in Nigeria
Authors: Ugwu I Omale
Journal: The Lancet Global Health (2021)

I thank Catherine Falade and Olugbenga Mokuolu1Falade CO Mokuolu OA The need for social group interventions to increase malaria rapid diagnostic test uptake in Nigeria.Lancet Glob Health. 2021; 9: e231-e232Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar for their Comment on our recent Article.2Omale UI Azuogu BN Alo C et al.Social group and health-care provider interventions to increase the demand for malaria rapid diagnostic tests among community members in Ebonyi state, Nigeria: a cluster-randomised controlled trial.Lancet Glob Health. 2021; 9: e320-e330Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar The authors rightly highlighted some of the factors that influence malaria rapid diagnostic test (MRDT) uptake in Nigeria. However, some of Falade and Mokuolus' statements might mislead readers with regards to our study. Thus, I need to make some clarifications to avoid any misunderstandings. Falade and Mokuolu1Falade CO Mokuolu OA The need for social group interventions to increase malaria rapid diagnostic test uptake in Nigeria.Lancet Glob Health. 2021; 9: e231-e232Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar incorrectly implied that our study2Omale UI Azuogu BN Alo C et al.Social group and health-care provider interventions to increase the demand for malaria rapid diagnostic tests among community members in Ebonyi state, Nigeria: a cluster-randomised controlled trial.Lancet Glob Health. 2021; 9: e320-e330Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar corroborates the findings by Bruxvoort and colleagues,3Bruxvoort KJ Leurent B Chandler CIR et al.The impact of introducing malaria rapid diagnostic tests on fever case management: a synthesis of ten studies from the ACT consortium.Am J Trop Med Hyg. 2017; 97: 1170-1179Crossref PubMed Scopus (33) Google Scholar who reported that, as paraphrased by the Comment: “most of the increase in MRDT uptake usually occurs among patients treated outside of health facilities” when MRDTs are introduced in a population. However, in our study, MRDT services were already available at local health facilities as part of standard practice (ie, MRDTs were not being introduced), and social groups were educated to request MRDTs for febrile or malaria-like illness within health facilities—we did not report on treatment outside of health facilities. In the Comment, Falade and Mokuolu1Falade CO Mokuolu OA The need for social group interventions to increase malaria rapid diagnostic test uptake in Nigeria.Lancet Glob Health. 2021; 9: e231-e232Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar state that a study by Mokuolu and colleagues4Mokuolu OA Ntadom GN Ajumobi OO et al.Status of the use and compliance with malaria rapid diagnostic tests in formal private health facilities in Nigeria.Malar J. 2016; 15: 4Crossref PubMed Scopus (17) Google Scholar reported that health-care providers preferred the use of microscopy rather than MRDTs in the diagnosis of malaria. The authors stated that these detrimental preferences and perceptions by health-care workers should be addressed before scaling up our findings.2Omale UI Azuogu BN Alo C et al.Social group and health-care provider interventions to increase the demand for malaria rapid diagnostic tests among community members in Ebonyi state, Nigeria: a cluster-randomised controlled trial.Lancet Glob Health. 2021; 9: e320-e330Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar These statements are misplaced in the context of our study; the study by Mokuolu and colleagues4Mokuolu OA Ntadom GN Ajumobi OO et al.Status of the use and compliance with malaria rapid diagnostic tests in formal private health facilities in Nigeria.Malar J. 2016; 15: 4Crossref PubMed Scopus (17) Google Scholar was done in urban and rural private hospitals in which both malaria microscopy and MRDT were in use, whereas our study involved rural public primary health facilities and patent medicine shops in which only MRDT was used. Moreover, patients' demands influence diagnostic and treatment practices used by health-care providers;5Wiseman V Ogochukwu E Emmanuel N et al.A cost-effectiveness analysis of provider and community interventions to improve the treatment of uncomplicated malaria in Nigeria: study protocol for a randomized controlled trial.Trials. 2012; 13: 81Crossref PubMed Scopus (13) Google Scholar, 6Altaras R Nuwa A Agaba B Streat E Tibenderana JK Strachan CE Why do health workers give anti-malarials to patients with negative rapid test results? A qualitative study at rural health facilities in western Uganda.Malar J. 2016; 15: 23Crossref PubMed Scopus (24) Google Scholar therefore, the perceptions of private providers need not be addressed before attempting to increase demand for MRDTs among community members.5Wiseman V Ogochukwu E Emmanuel N et al.A cost-effectiveness analysis of provider and community interventions to improve the treatment of uncomplicated malaria in Nigeria: study protocol for a randomized controlled trial.Trials. 2012; 13: 81Crossref PubMed Scopus (13) Google Scholar Falade and Mokuolu1Falade CO Mokuolu OA The need for social group interventions to increase malaria rapid diagnostic test uptake in Nigeria.Lancet Glob Health. 2021; 9: e231-e232Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar also state that we did not specify whether MRDTs were provided for free during the study.2Omale UI Azuogu BN Alo C et al.Social group and health-care provider interventions to increase the demand for malaria rapid diagnostic tests among community members in Ebonyi state, Nigeria: a cluster-randomised controlled trial.Lancet Glob Health. 2021; 9: e320-e330Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar The provision of MRDT services was standard practice and not part of the interventions we delivered, thus we could not specify whether MRDTs were provided for free. Finally, their statement, that health-care interventions which involved only mothers were likely to lead to poor uptake because fathers made decisions on the treatment of their ill child more often than mothers, was misplaced. Readers should note that the social group sensitisation and education interventions in our study2Omale UI Azuogu BN Alo C et al.Social group and health-care provider interventions to increase the demand for malaria rapid diagnostic tests among community members in Ebonyi state, Nigeria: a cluster-randomised controlled trial.Lancet Glob Health. 2021; 9: e320-e330Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar targeted all community members and assessment of the outcome (demand for MRDTs) was among everyone, except pregnant women, and not only children. I declare no competing interests. The need for social group interventions to increase malaria rapid diagnostic test uptake in NigeriaCorrect diagnosis is key to appropriate treatment of any disease, whether infectious or otherwise, and is particularly pertinent for the diagnosis of malaria and, consequently, appropriate treatment. Parasite-based diagnosis of malaria reduces unnecessary use of artemisinin-based combination therapy and the chances of emergence of resistant strains of Plasmodium spp.1 Parasite-based diagnosis also enhances surveillance and early diagnosis of non-malaria febrile illnesses such as pneumonia and other viral illnesses in children. Full-Text PDF Open Access