A qualitative study exploring factors associated with the accuracy of recording malaria rapid diagnostic test results in two high-burden regions of Côte d'Ivoire.
7 affiliations
- 1Malaria Research and Control Centre, National Institute of Public Health, BPV 47, Abidjan, Côte d'Ivoire. [email protected].
- 2Malaria Research and Control Centre, National Institute of Public Health, BPV 47, Abidjan, Côte d'Ivoire.
- 3Department of Parasitology, Mycology, Animal Biology and Zoology, Felix Houphouët-Boigny University, Abidjan, Côte d'Ivoire.
- 4PMI Insights Project, PATH, Seattle, WA, USA.
- 5National Malaria Control Program, Abidjan, Côte d'Ivoire.
- 6U.S. President's Malaria Initiative, USAID, Washington, DC, USA.
- 7PMI Insights, PATH, Geneva, Switzerland.
Abstract
Background
While the expanded use of malaria rapid diagnostic tests (RDTs) in Sub-Saharan Africa has improved testing rates, healthcare workers do not always adhere to results or report them accurately. Because misrecording RDT results compromises malaria surveillance, this study identified factors associated with providers' guideline adherence and accurate RDT reporting in in two high-burden regions in Côte d'Ivoire.Methods
This qualitative study was embedded within a mixed-methods evaluation of RDT reporting and recording accuracy called the Malaria RDT Capture and Reporting Assessment (MaCRA). Healthcare workers performed RDTs for patients with suspected malaria and recorded interpretations in registers. RDTs were photographed and independently read by an external panel; agreement was measured using Cohen's kappa. Sixteen healthcare workers (eight high agreement, eight low agreement) with ≥ 75 recorded results were purposively selected across regions and districts. Semi-structured interviews in French covered RDT knowledge, perceived self-efficacy for performing and interpreting RDTs, perceived risks, subjective norms, guidelines, and health system context. Blinded analysts coded transcripts in NVivo using deductive and inductive approaches to compare themes between groups.Results
Perceptions of RDT reliability, particularly confidence in negative results for symptomatic patients, was the primary differentiator between groups. Low-agreement participants more frequently feared false-negative results and severe consequences of failing to provide antimalarials, contributing to prescribing antimalarials after a negative RDT. Several described deliberate misrecording to align registers with treatment decisions, including changing negative results to positive or omitting antimalarial documentation to avoid scrutiny. Conversely, some high-agreement participants documented these cases as "presumed" malaria rather than falsifying results.Conclusions
Differences in guideline adherence and RDT recording were driven by risk perceptions and confidence in results rather than a lack of procedural knowledge, guideline access, or supply constraints. Interventions should target clinical decision-making for RDT-negative fevers through supportive supervision, expand non-malarial diagnostic options, and strengthen documentation systems to record non-adherence transparently and without incentivizing misreporting.
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BibTeX
@article{kouakou2026qualitative,
title = {{A qualitative study exploring factors associated with the accuracy of recording malaria rapid diagnostic test results in two high-burden regions of Côte d'Ivoire.}},
author = {Orphée M A Kouakou and Valérie A Bédia-Tanoh and Annie Arnzen and Abibatou Konaté-Toure and Saadjo Sow and Antoine M Tanoh and Michael Humes and Kevin Griffith and Kim A Lindblade and William Yavo},
journal = {Malaria journal},
year = {2026},
month = jul,
doi = {10.1186/s12936-026-06053-1},
url = {https://europepmc.org/article/MED/42897538},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - A qualitative study exploring factors associated with the accuracy of recording malaria rapid diagnostic test results in two high-burden regions of Côte d'Ivoire.
AU - Orphée M A Kouakou
AU - Valérie A Bédia-Tanoh
AU - Annie Arnzen
AU - Abibatou Konaté-Toure
AU - Saadjo Sow
AU - Antoine M Tanoh
AU - Michael Humes
AU - Kevin Griffith
AU - Kim A Lindblade
AU - William Yavo
PY - 2026
DA - 2026/07/01
JO - Malaria journal
DO - 10.1186/s12936-026-06053-1
UR - https://europepmc.org/article/MED/42897538
AB - Background While the expanded use of malaria rapid diagnostic tests (RDTs) in Sub-Saharan Africa has improved testing rates, healthcare workers do not always adhere to results or report them accurately. Because misrecording RDT results compromises malaria surveillance, this study identified factors associated with providers' guideline adherence and accurate RDT reporting in in two high-burden regions in Côte d'Ivoire.Methods This qualitative study was embedded within a mixed-methods evaluation of RDT reporting and recording accuracy called the Malaria RDT Capture and Reporting Assessment (MaCRA). Healthcare workers performed RDTs for patients with suspected malaria and recorded interpretations in registers. RDTs were photographed and independently read by an external panel; agreement was measured using Cohen's kappa. Sixteen healthcare workers (eight high agreement, eight low agreement) with ≥ 75 recorded results were purposively selected across regions and districts. Semi-structured interviews in French covered RDT knowledge, perceived self-efficacy for performing and interpreting RDTs, perceived risks, subjective norms, guidelines, and health system context. Blinded analysts coded transcripts in NVivo using deductive and inductive approaches to compare themes between groups.Results Perceptions of RDT reliability, particularly confidence in negative results for symptomatic patients, was the primary differentiator between groups. Low-agreement participants more frequently feared false-negative results and severe consequences of failing to provide antimalarials, contributing to prescribing antimalarials after a negative RDT. Several described deliberate misrecording to align registers with treatment decisions, including changing negative results to positive or omitting antimalarial documentation to avoid scrutiny. Conversely, some high-agreement participants documented these cases as "presumed" malaria rather than falsifying results.Conclusions Differences in guideline adherence and RDT recording were driven by risk perceptions and confidence in results rather than a lack of procedural knowledge, guideline access, or supply constraints. Interventions should target clinical decision-making for RDT-negative fevers through supportive supervision, expand non-malarial diagnostic options, and strengthen documentation systems to record non-adherence transparently and without incentivizing misreporting.
SN - 1475-2875
ER -