Funding and compliance to Test-Before-Treat recommendation in management of uncomplicated malaria among primary health care workers in Anambra State, Nigeria - a cross-sectional comparative study.

Introduction: in 2010, Nigeria adopted the Test-Before-Treat recommendation in her "national guideline for diagnosis and treatment of malaria." Across Nigeria, donor agencies including the Global Fund to Fight AIDS, Tuberculosis and Malaria, support states in malaria control, particularly at the Primary Healthcare level. This study aims to compare compliance to Test-Before-Treat recommendations in managing uncomplicated malaria among health workers in global fund-supported and government-supported Primary Healthcare Centers (PHCs) in Anambra State.

Methods: a cross-sectional comparative study involving 32 PHCs across Anambra State. Using multi-stage sampling, the facilities were selected from four local government areas in two of the three senatorial zones. Data were collected using 1536 proforma for retrospective audit of case records, 82 health worker questionnaires, 32 facility assessment questionnaires, and 32 observational checklists for health facility inventory; and analyzed using IBM SPSS Statistics version 20. The Chi-square test of independence and Fisher's exact test was used to determine the association between categorical variables. Statistical significance (p) was set at 0.05.

Results: compliance with Test-Before-Treat recommendations in global fund-supported PHCs was 99% (760/768) versus 84% (645/768) in the government-supported (p=0.00). Comparatively, global fund-supported PHCs had higher availability of free malaria rapid diagnostic test kits (mRDT), job aids, copies of national guidelines in consulting rooms, staff with recent training on mRDT, and staff recently exposed to supervision.

Conclusion: donor fund supports enhanced compliance to Test-Before-Treat recommendations by increasing the availability of free mRDT kits, job aids, National Guidelines, and frequency of staff exposure to supervision and training on mRDT.