Ayandipo Esther Oluwayemisi, Fagbola Motunrayo, Gbolade Adetomiwa, Okpokpolom Jay Thomas, Ojo Abiodun, Abikoye Olatayo, Nglass IniAbasi, Abimbola Olayemi, Firima Augustine, Huestis Arja, Abass Gbolahan, Olatunji Babatunde, Adesanya Olufemi, Momoh Veronica, Nwankwo Grace, Dagba Erkwagh, Mihigo Jules, Nwokenna Uchenna
Management Sciences for Health, Abuja, Nigeria.
Oyo State Ministry of Health, Ibadan, Nigeria.
Malar J. 2025 Apr 22;24(1):132. doi: 10.1186/s12936-025-05352-3.
The malaria test positivity rate (TPR) is a key indicator for evaluating the effectiveness of malaria interventions. In Nigeria, routine data from January to June 2021 reported consistently high TPRs, ranging from 73 to 82%, while Oyo State reported TPRs of 70% to 74% during the same period. These figures were inconsistent with malaria therapeutic efficacy studies conducted between October 2009 and November 2010, which reported a much lower TPR of 35%. This discrepancy raised concerns about data quality, increased malaria incidence, or inaccuracies in malaria diagnosis.
This study assessed the effect of two interventions aimed at improving the accuracy of TPR data using secondary quantitative data from the National District Health Information System (NDHIS) for both Primary Healthcare Facilities (PHFs) and Secondary Health Facilities (SHFs). The interventions included (1) facility-level audits of used malaria Rapid Diagnostic Test (RDT) cassettes archived at 733 PHFs, initiated in September 2021, and (2) a 10-day basic malaria microscopy training (BMMT) for Laboratory Scientists at 17 SHFs, completed in September 2021.
At PHFs, the RDT positivity rate declined from 71% in October 2021 to 53% in December 2022. A period review from January to September revealed a decrease in TPR from 62 to 53% in 2022, compared to no difference in TPR for the same period in 2021 with an average TPR of 77%. A paired t-test comparing the mean TPR for each period showed a statistically significant decline of 19.56 (t = 18.081, p < 0.01, CI (17.06-22.05). At SHFs, microscopy-based TPR decreased from 40% in October 2021 to 18% in December 2022. A review of January to September 2021 showed a TPR decline from 53 to 50%, while in 2022, TPR decreased from 25 to 18%. A paired t-test revealed a statistically significant decline of 19.33 in mean TPR at SHFs (t = 8.14, p < 0.01, CI 13.86-24.81).
This study highlights the critical role of auditing used RDT cassettes and recommends scaling up this approach in PHFs. It also underscores the value of basic malaria microscopy training in improving the quality and accuracy of microscopy-based diagnosis. One limitation of this study is the absence of comparative data from other states in Nigeria where the interventions were not implemented.
疟疾检测阳性率（TPR）是评估疟疾干预措施有效性的关键指标。在尼日利亚，2021年1月至6月的常规数据显示TPR一直居高不下，在73%至82%之间，而同期奥约州报告的TPR为70%至74%。这些数据与2009年10月至2010年11月进行的疟疾治疗效果研究不一致，该研究报告的TPR要低得多，为35%。这种差异引发了对数据质量、疟疾发病率上升或疟疾诊断准确性的担忧。
本研究利用国家地区卫生信息系统（NDHIS）提供的初级卫生保健机构（PHF）和二级卫生保健机构（SHF）的二级定量数据，评估了旨在提高TPR数据准确性的两项干预措施的效果。干预措施包括：（1）2021年9月开始对733个PHF存档的已使用疟疾快速诊断检测（RDT）试剂盒进行机构层面的审计；（2）2021年9月为17个SHF的实验室科学家完成了为期10天的基本疟疾显微镜检查培训（BMMT）。
在PHF，RDT阳性率从2021年10月的71%降至2022年12月的53%。对1月至9月期间的回顾显示，2022年TPR从62%降至53%，而2021年同期TPR无差异，平均TPR为77%。对各时期平均TPR进行配对t检验，结果显示有统计学意义的下降，降幅为19.56（t = 18.081，p < 0.01，CI（17.06 - 22.05）。在SHF，基于显微镜检查的TPR从2021年10月的40%降至2022年12月的18%。对2021年1月至9月的回顾显示，TPR从53%降至50%，而在2022年，TPR从25%降至18%。配对t检验显示，SHF的平均TPR有统计学意义的下降，降幅为19.33（t = 8.14，p < 0.01，CI 13.86 - 24.81）。
本研究突出了审计已使用RDT试剂盒的关键作用，并建议在PHF扩大这种方法。它还强调了基本疟疾显微镜检查培训在提高基于显微镜检查的诊断质量和准确性方面的价值。本研究的一个局限性是缺乏来自尼日利亚其他未实施干预措施的州的比较数据。
