Diagnostic testing by CHWs
malaria
MALARIA
In total, 32 404 mRDTs were conducted by the CHWs over the intervention period, and 33.7% (n=10 870) were positive. Those with a positive test received a voucher for a discounted quality-assured AL. These vouchers were redeemed at a participating outlet by 93.9% of voucher recipients. There were no instances of stock out of mRDTs among our CHWs. To explore factors that may be associated with the CHWs’ ability to conduct mRDTs, we examined the association between testing volume, defined as the mean number of mRDTs conducted per month, and the different CHW demographic characteristics (Association between mean number of tests performed per month and CHW characteristicsTwo hundred seventy-two CHWs were trained, of which 28 were missing one or more of marital status, employment status, previous RDT training or education level. The 244 with complete data are reported here.Bold indicate results significant to p<0.05.*Number of households for which the CHW reported being responsible.†Percentage of mRDTs conducted by the CHWs in that cluster, which turned positive over the study period.CHW, community health worker; mRDT, malaria rapid diagnostic test.In a multivariate analysis, formal employment, previous mRDT training, number of households and mRDT positivity rate at the cluster level were associated with volume of tests done. Sex, age, being married and education level were not significantly associated with testing volume. CHWs who were formally employed in some other capacity alongside their CHW voluntary work performed on average 1.37 more tests per month (adjusted coefficient=1.37, 95% CI: 0.05 to 2.70), but those who reported being trained previously on mRDTs performed 1.4 fewer tests per month (adjusted coefficient=1.4, 95% CI: −2.44 to –0.37). CHWs serving areas with a high proportion of positive tests (proportion of mRDT positive results >25%) tested on average two more clients per month than those in lower prevalence areas (adjusted coefficient=2.14, 95% CI: 1.05 to 3.22). CHWs who were responsible for at least 50 households tested more clients (adjusted coefficient=1.73, 95% CI: 0.70 to 2.74), although this did not increase further when the number of households exceeded 100 (adjusted coefficient=1.49, 95% CI: 0.74 to 2.24).Univariate and multivariate analyses were conducted to test the association between testing volume and CHW perceptions about their role at the midpoint of the intervention period (Association between mean number of tests per month and CHW perceptions about their role at the midpoint surveyMultivariate ORs are adjusted for age, gender, education level and formal employment. The analysis includes a random sample of CHWs selected for midpoint evaluation.Bold indicate results significant to p<0.05.*mRDT score—-CHW scored >17 correct steps on a 20-step checklist for mRDT preparation and interpretation conducted 6 months after training.†Equals 1 if malaria testing was cited as their most important activity or 0 if they cited any other activity as most important.‡Equals 1 if the CHW cited money, or 0 if the CHW only cited non-monetary incentives or desire for recognition as important motivators for their role as a CHW.§Client score was derived from four questions where the CHW reported how confident clients were in the testing they provided.CHW, community health worker; mRDT, malaria rapid diagnostic test.