Testing times: trends in availability, price, and market share of malaria diagnostics in the public and private healthcare sector across eight sub-Saharan African countries from 2009 to 2015

摘要: The World Health Organization guidelines have recommended that all cases of suspected malaria should receive a confirmatory test with microscopy or rapid diagnostic (RDT), however evidence from sub-Saharan Africa (SSA) illustrates only one-third children under five recent fever received test. aim this study was to evaluate availability, price and market share RDT 2009/11 2014/15 in 8 SSA countries, better understand barriers improving access testing the public private health sectors. Repeated national cross-sectional quantitative surveys were conducted among sample outlets stocking anti-malarial medicines and/or diagnostics. In total, 169,655 screened. Availability blood screened facilities increased significantly between first survey wave most Benin (36.2, 85.4%, p < 0.001), Kenya (53.8, 93.0%, mainland Tanzania (46.9, 89.9%, Nigeria (28.5, 86.2%, Katanga, Democratic Republic Congo (DRC) (76.0, 88.2%, p < 0.05), Uganda (38.9, 95.6%, p < 0.001). These findings attributed an increase availability RDTs. Diagnostic remained high Kinshasa (the DRC) (87.6, 97.6%) Zambia (87.9, 91.6%). Testing decreased Madagascar (88.1, 73.1%, p < 0.01). round, majority performed sector (90.9%), (90.3%), (84.5%), Katanga (74.3%), (73.5%), (71.8%), (68.4%), (53.2%) (51.9%). sector, significant increases tests for-profit observed final rounds (82.1, 94.0%, (37.0, 66.0%, (52.8, 74.3%, (66.8, 93.5%, p < 0.01), (47.1, 70.1%, (14.5, 45.0%, Blood low over time (33.1, 20.7%), (94.4, 87.5%), falls (72.7, 55.6%, p < 0.05). pharmacies drug stores—which are common source medicines—was rare settings, highest 2015 (21.5%). Median for child equal pre-packaged quality-assured artemisinin-based combination therapy (QAACT) treatment two-year old some 1.5–2.5 times higher others. QAACT adult varied having parity being up 2 more expensive. exception both where median less expensive than Significant strides been made testing, mainly through widespread distribution RDT, especially facilities. universal coverage can be very particularly stores, which responsible distribution. Where available, may serve as barrier uptake, young children. Several initiatives introduced into modified expanded means close gap promote diagnosis.