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Table 1 Rapid diagnostic test perceptions and managing non-malaria paediatric fevers

From: It could be viral but you don’t know, you have not diagnosed it: health worker challenges in managing non-malaria paediatric fevers in the low transmission area of Mbarara District, Uganda

Low parasite/antigen load

Previous anti-malarial dose

Test detection of only one species

But mostly we prefer the high temperature for about like 2 days. So we decide [to test using RDT]. (Health worker 13)

She comes here and she tells you that she has already taken 4 tabs [of malaria treatment] from somewhere. So you get a sample from her and you do an RDT. The RDT can come negative. But since she has already told you that she has taken the treatment, you give her treatment to finish the course. (Health worker 13)

I think if it’s some other Plasmodium it could be malaria but not detected using the RDT. (Health worker 5)

For RDTs it is rare to confirm malaria when the parasites [sic] have just developed fever. But if somebody has been down and has not been getting treatment there you can confirm [using RDT]. (Health worker 14)

In most cases you find when a patient is taking anti-malarials you test there is no fever, I mean there is no malaria. I think you take the patient to another step or second drug, second choice of drug or you refer to health centre IV for management. (Health worker 19)

The RDT tests only for one species of malaria. The person could be having other types of malaria and when you give the treatment, although the result was negative, the person responds. (Health worker 8)

Malaria is still starting and has not yet spread out. So it is difficult to detect, for example, if somebody contracted malaria last night and you test today, it will be hard for you. (Health worker 14)

When the child has not taken any anti-malarial, and has taken like 34 days, and the blood slide is negative there we totally don’t treat malaria. (Health worker 4)

 

Sometimes when the malaria parasites are hidden you give an anti-malarial, and some do improve. (Health worker 15)

When they have taken coartem from the health centres or from the drug shops anywhere, so there you ask if she has taken any treatment. Then if it’s there you give the second line. (Health worker 4)

 

I think these RDTs to become positive that malaria might have persisted or it might have taken like 3 days. But the malaria of 1 day cannot be positive on an RDT. It can’t. (Health worker 18)

We take the history, if there is a fever and some other presenting complaints maybe there has been headache, vomiting, then also if the child has not been on anti-malarial treatment before we test using RDT. But if he has been on anti-malarials before, we go on for microscopy. (Health worker 5)

 

When she spent there like 3 days is when you get the reaction immediately after testing using the RDTs. But sometimes when that person got fever at that moment and comes for RDTs we don’t get immediate results from the malaria parasites, so we advise that person maybe we treat that person clinically. (Health worker 2)

Like someone may say I took some anti-malarials a week before. No improvement. My child still has fever. You do RDT and it tests negative but clinically you see this child might be having fever. So we go ahead and do microscopy. (Health worker 9)

 

When somebody comes and you give the first test immediately and you cannot get positive response. But if someone is sick for 3 or 4 days back you get the positive results. (Health worker 2)

Sometimes when someone has taken anti-malarials it is hard for an RDT to test positive. (Health worker 9)

 

When the child has not taken any anti-malarial, and has taken like 34 days, and the blood slide is negative, there we totally don’t treat malaria. (Health worker 4)

But also what helps to diagnose malaria if the RDT is negative, some caretakers give anti-malarials like days before they come. But it is always not a complete dose. The RDT will tell us negative. But if the caregiver tells us the truth that I gave anti-malarials and I didn’t complete the dose, we start afresh. (Health worker 5)

 

Because of the incubation period. If the incubation period has not ended then we treat [for malaria]. (Health worker 4)

Some of us go to clinics first and we are given medicine without testing. So the malaria parasites hide. But somehow when they go to test elsewhere the malaria is not detected but the doctor kind of understands this and goes ahead and treats malaria. (FGD 1 participant)

 

You may find the child having fever for 2 days. That one I can easily go and RDT test. (Health worker 11)

  

I took my child and they tested him, and they detected few malaria parasites, so they gave treatment for malaria because the malaria parasites would eventually increase if left untreated and cause serious malaria. (FGD 2 participant)

  

What happens is that you see a child has high temperature, you may doubt. Even if they say it is not there, but it could rise so you buy medicine in preparation. (FGD 5 participant)

  

This is what they say, they say they have a gadget they use to test and say that the malaria is not yet in the blood. It is still in the lungs [sic], and so they give you anti-malarial drugs. (FGD 7 participant)