Low practical knowledge but high willingness to use malaria rapid diagnostic tests among healthcare workers in the Republic of Congo

Abstract

BACKGROUND: Malaria rapid diagnostic tests (mRDTs) are essential for early detection and effective management of malaria, but their success depends on healthcare workers' (HCWs) knowledge, attitudes, and practices regarding their use. This study described these factors and aimed to identify the key barriers that must be addressed to improve diagnostic malaria practices in the country. METHODS: A descriptive cross-sectional study was conducted from November 2024 to February 2025 across 09 health districts in Brazzaville department. Using a two-stage random sampling strategy, 36 public and private primary healthcare facilities were selected, with 211 HCWs involved in malaria diagnosis were enrolled. Data were collected through, a pre-tested semi-structured questionnaire that was self-administered by participants in the presence of the data collector, who provided clarification when participants encountered difficulties understanding certain items, and were analysed using R software (version 4.2.3). Group comparisons of proportions were performed using the Chi-square test (or Fisher's exact test when expected cell frequencies were below 5. Knowledge, attitude and practice scores were computed from predefined items and classified as good (≥ 75%), intermediate (50-74.9%), or insufficient (< 50%). RESULTS: Among participants, 96% reported using mRDTs, though only 36% had received specific training. General malaria knowledge was low, with just 9% scoring good. Most (90%) had poor understanding of target antigens and diagnostic procedures. However, 97% and 59% perceived mRDTs as easy to use and reliable, respectively. In practice, 85.8% used both mRDTs and microscopy, but only 7.6% followed national guidelines. Following negative mRDTs in symptomatic patients, 39% requested microscopy, and 27% prescribed antimalarials based on clinical suspicion. No significant associations were found between knowledge, attitudes or practices and demographic or professional characteristics. CONCLUSION: Although mRDTs usage is widespread among HCWs in Brazzaville department, significant gaps persist in their knowledge, attitudes, and practices regarding national diagnostic protocols. Enhanced training and policy enforcement are needed to strengthen malaria case management in the Republic of Congo.