Characteristics of healthcare workers and health facilities associated with inaccurate recording of malaria rapid diagnostic test results - a multi-country study

Sep 28, 2026

Malaria rapid diagnostic tests (RDTs) improve case management and surveillance across sub-Saharan Africa, yet inaccuracies in how healthcare workers (HCWs) record RDT outcomes can undermine both clinical decisions and reporting quality. This multi-country mixed-methods study assessed how HCW demographic characteristics, attitudes toward RDTs, and RDT proficiency related to the accuracy of recorded malaria RDT results. Evidence shows misrecording patterns differ by country, influenced by knowledge, beliefs, job cadres, and facility context.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages18

Reading Time45 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Atobatele et al. Malaria Journal (2026) 25:4 [https://doi.org/10.1186/s12936-025-05674-2](https://doi.org/10.1186/s12936-025-05674-2) Malaria Journal RESEARCH Open Access Characteristics of healthcare workers and health facilities associated with inaccurate recording of malaria rapid diagnostic test results: a multi-country study Sunday Atobatele1,2*, Arthur Mpimbaza3, Corine Ngufor4, William Yavo5, Abibatou Konate‑Toure5, Idelphonse Ahogni4, Nelson Ssewante3, Evelyn Orya1, Ese Akpiroroh1, Onyebuchi Okoro6, Bosco Agaba14, Augustin Kpemasse8, Jacques Agnon9, Antoine MeaTanoh9, Cyriaque Affoukou8, Jimmy Opigo7, Godwin Ntadom6, Hilary Okagbue2, Eugene C. Eugene 1, John J. Aponte 10, Emily Hilton11, Natalie Galles11, Radina Soebiyanto12, Shawna Cooper13, Chukwu Okoronkwo6, Michael Humes 12, Kevin Griffith12, Kim A. Lindblade 10 and Sidney Sampson1,14 Abstract Background Malaria rapid diagnostic tests (RDTs) have improved case management and surveillance across sub‑ Saharan Africa by reducing presumptive treatment and enhancing diagnostic specificity. However, healthcare workers’(HCWs) concerns about limitations of RDTs, the lack of other diagnostic tools and patient expectations may result in non‑adherence to RDT outcomes in treatment decisions. This study aimed to determine associations between HCW characteristics and the accuracy of recording malaria RDT results. Methods A multi‑country, mixed‑methods observational study was conducted in 64 public health facilities across Benin, Côte d’Ivoire, Nigeria, and Uganda between June and December 2023. HCW demographic character‑ istics, attitudes and perceptions of RDTs, and proficiency performing RDTs were collected via surveys and structured observations. Completed RDTs were photographed, interpreted by a trained panel, and compared with health facility registers. Multivariable logistic regression models were used to identify factors associated with misrecording. Results Among more than 100,000 RDTs performed by 499 HCWs, 5.1–7. 3% of results were misrecorded as positive, and 0.7–3. 7% were misrecorded as negative. The test positivity rate (TPR) was highest in Côte d’Ivoire (59 . 7%) and low‑ est in Nigeria (45 . 3%) . Overall agreement on RDT results between the external panel and the result recorded by HCWsin the health facility register ranged from 90. 2% in Nigeria to 94. 3% in Benin. Misrecording of negative or invalid results as positive varied by country. In Benin, older HCWs and those with stronger malaria knowledge were less likely to misrecord, but HCWs who believed patients should still be treated after a negative test were more likely to do so. In Côte d’Ivoire, community health workers had higher odds of misrecording, while higher education reduced the risk. In Nigeria, medical auxiliary staff were less likely to misrecord than other cadres. In Uganda, misrecording was more common in high‑volume, high‑positivity facilities and among HCWs recently observed by a supervisor. *Correspondence: Sunday Atobatele [sunday.atobatele@sydani.org](sunday.atobatele@sydani.org) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, vi

FAQs

What was the study designed to determine?

To assess associations between healthcare workers’ characteristics and the accuracy of recording malaria RDT results.

How were RDT results and recording accuracy measured?

Completed RDTs were photographed, interpreted by a trained panel, and compared with health facility registers; surveys and structured observations captured HCW factors.

Which factors were linked to misrecording, and did patterns vary by country?

Yes. Older HCWs and stronger malaria knowledge reduced misrecording in Benin, while beliefs that patients should be treated after a negative test increased it. Higher education reduced risk in Côte d’Ivoire, medical auxiliary staff misrecorded less in Nigeria, and misrecording was more common in high-volume, high-positivity facilities in Uganda.

Sep 28, 2026

Upload by CatatanPagi