Skip to Navigation
London School of Hygiene & Tropical Medicine Malaria Centre

Malaria research in social and economic studies

Research on the economics of ACT (REACT): qualitative situation analysis to inform the design of interventions to support improved use of ACT in Nigeria.

LSHTM investigators:
Virginia Wiseman, Lindsay Mangham & Clare Chandler.
External collaborators:
Obinna Onwujekwe, Ogo Exeoke Nkoli Ezumah & Benjamin Uzochukwu (University of Nigeria, Nigeria).
Funding body:
Bill & Melinda Gates Foundation through the ACT Consortium.

The adoption of ACTs as the first line treatment for uncomplicated malaria in Nigeria has concentrated attention on the role of testing for appropriate diagnosis for malaria.

There are calls at both national and global level for malaria treatment to be based on test result, but it is still unclear how these tests can be incorporated into treatment seeking and practices of health providers. This study explored both community and providers’ perceptions and experiences with malaria tests in south east Nigeria.

The study was conducted in an urban (Enugu) and a rural (Udi) area of Nigeria. A total of 18 focus group discussions were conducted with 179 community members and 26 in-depth interviews were conducted with public and private health providers involved in prescribing medicines in the study area.

Most people had experienced malaria tests and both providers and community members identified this as an important step to distinguish malaria from other illnesses with similar symptoms and to give appropriate treatment. However, in practice antimalarial treatment was often used presumptively, without a positive test result. The logic of test-directed treatment was undermined by cost of testing and a lack of facilities but above all concerns over the reliability of negative test results, with community members and providers observing inconsistencies between results and symptoms, and providers attributing inaccurate results to incompetencies of technicians. Recognition of malaria symptoms was deemed most important in determining the use of antimalarial drugs.

To tackle these issues, the REACT project designed intervention packages targeted at providers and community members. The core message of test-directed Artemisinin Combination Treatment is supported by provision of Rapid Diagnostic Tests, interactive learning and integration with other components of care for providers, and a school-based peer education programme with community-oriented malaria event to increase awareness and demand amongst care seekers. These interventions are being evaluated with a 3-arm cluster randomised trial