Practical facility-level approaches to reduce the malaria test positivity rate in Oyo State, Nigeria dataset.csv

The malaria test positivity rate (TPR) is used to assess the effectiveness of malaria interventions. However, over the years, this rate has remained high in routine data across Nigeria, including Oyo state. The high TPR was inconsistent with other data triangulated from therapeutic efficacy studies and fever monitoring exercises reporting a national TPR average of 49-52%, suggesting that the high TPR may reflect poor quality data and poor conduct of malaria diagnosis. This study reports on the effect of the two measures introduced to improve the accuracy of TPR data using secondary quantitative data from the National District Health Information System (DHIS) for both primary healthcare centers (PHCs) and Secondary Health Facilities (SHFs). The two measures were facility-level audits of mRDT cassettes archived at 733 PHCs introduced in September 2021 and 10 days of basic malaria microscopy training (BMMT) at 17 SHFs completed in June 2021. There was a sustained decline in the rate of mRDT positivity from 76% in August 2021 to 53% in December 2022. Furthermore, a period review from January to December 2022 revealed that the TPR decreased from 61% to 53% compared with that from January to December 2021, with a TPR decrease from 72% to 61%. An independent t test was performed to compare the mean TPR for each year, with a statistically significant decline noted. (t=9.306, p<0.01 CI=10.73-16.94) At SHF, following the BMMT in September 2021, the microscopy-based TPR declined from 50% in September 2021 to 18% in December 2022. A review of the period from January to December 2021 showed a decrease in TPR from 53%-29%, compared to January to December 2022 with TPR decrease from 25%-31%. An independent t test was performed to compare the mean TPR for each year in the SHFs, with a statistically significant decline noted (t=7.52, p<0.01 CI=12.36-21.98). This study concluded that supervised archiving and auditing of cassettes is a model that may be considered for future scale-up to PHCs, while BMMT should be further encouraged for accurate microscopy-based diagnosis. The findings reinforce the critical role of capacity building of human resources and the influence of audits on increasing the accuracy of malaria diagnosis and data reporting. In conclusion, this study advocates for the importance of supervised archiving and auditing of cassettes as a model for potential scale-up to PHCs. This study also highlights the effectiveness of basic malaria microscopy training for accurate microscopy-based diagnosis. These findings underscore the critical role of capacity building of human resources and the influence of mRDT cassette audits on improving the accuracy of malaria diagnosis and data reporting.