Implementation and Acceptability of the Malaria Rapid Diagnostic Test (mRDTs) in Pharmacies: A Pilot Study in Libreville, Gabon

Abstract

Background: Anyone suspected of malaria should undergo biological confirmation using microscopic examination (thick smear) or a rapid diagnostic test (RDT) and be treated with a combination therapy based on artemisinin (ACT) or an artemisinin derivative according to the severity of the disease as per the World Health Organisation (WHO) recommendations. Due to their ease of use and rapid results, RDTs are currently introduced into community-based care and recommended by malaria national control programmes in many countries. Aim: The study aimed to conduct a pilot study on the acceptability of the implementation of malaria rapid diagnostic test (mRDTs) in pharmacies. Methodology: This was a cross-sectional analytical study. The study was conducted from January to August 2022 in four pharmacies in the Estuaire province of Gabon. Data on the experiences and acceptance of mRDTs by workers and their customers                   were collected. Customers were tested using the MALARIA SD Bioline Ag Pf/Pan test.           Qualitative variables were presented as frequencies and analysed using the chi-square                    test, while quantitative variables were presented as means. A p-value < 0.05 was considered significant. Results: A total of 70 pharmacy workers and 200 customers were included. Among workers, 95.4% had used RDTs for less than 3 years, and almost all agreed with the introduction of mRDTs in pharmacies. Nevertheless, 14.3% of them sold antimalarial drugs based on a customer's request, even if their test was negative, and they mainly tested febrile customers (p< 0.001). Fifty per cent of clients had been informed about RDTs before their interview, but only 5.5% had used them in a pharmacy. Most clients (>90%) stated that it would be useful to have the test and agreed to pay for it. The pain associated with the blood sampling was the main disadvantage reported by the clients. The test was positive in half of the clients. Conclusion: All participants approved the introduction of mRDTs in pharmacies as they understood the importance of diagnosing all suspected cases. However, antimalarial drugs were still given to people with a negative test. National Malaria Control Programme campaigns could improve compliance with mRDT results in pharmacies.