Access to a blood test and antimalarials after introducing rapid diagnostic tests in rural Myanmar: initial experience in a malaria endemic area.

This study describes the use of a blood test, antimalarials and their determinants among 446 subjects with febrile illness in remote villages of Bago Division, Myanmar in 2006 after five months initialization of a rapid diagnostic test (RDT) and artemisinin-based combination therapy (ACT) programme. A structured questionnaire was used in a cross-sectional survey. Knowledge on malaria was asked of 357 key household respondents. The proportions of use of traditional medicine, modern medicine and both among febrile subjects were 31 (7.0%), 247 (55.4%) and 168 (37.7%), respectively. A blood test was taken by 41.0% of respondents and, of these, 81.4% were reported positive. Among 166 artesunate users, 45.8% reported positive test results and 18.1% were self-medicated. Only 37 (10.4%) key household respondents did not have misconceptions on malaria transmission. Predictors for having a blood test were being male (odds ratio [OR] = 1.96; 95% CI 1.20-3.22), having a higher knowledge on malaria (OR = 1.77; 95% CI 1.03-3.06) and aged 50 years or above (OR = 0.32; 95% CI 0.13-0.78). Predictors for having both a blood test and using artesunate were being male (OR = 2.71; 95% CI 1.31-5.59) and having a higher knowledge on malaria (OR = 2.49; 95% CI 1.27-4.92). The low coverage of proper clinical services and high prevalence of ineffective drug use confirmed the need for further strengthening of the programme.