Effect of malaria training on community healthcare providers’ compliance with malaria treatment guidelines in Nigeria using propensity score matching

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INTRODUCTION: Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) are important primary sources of care for many Nigerians. They are the first line of contact for those seeking advice or treatment for fever. However, the process needs to be strengthened and aligned with the World Health Organization (WHO) malaria treatment guidelines, as these providers currently diagnose based solely on symptoms. The IntegratE Project 2.0 is piloting innovative models to expand quality family planning and primary health care services through CPs and PPMVs across 11 Nigerian states, while generating evidence for policy reform. Our evaluation examines the effect of the malaria training module on knowledge, acceptability, and compliance with WHO treatment guidelines and identification of quality drugs among CPs and PPMVs, using a propensity score matching (PSM) analysis. METHODS: A quasi-experimental evaluation design with a comparison group was implemented. Baseline and follow-up data were collected from February 2022 to December 2022 using structured questionnaires from self-selected intervention and randomly selected comparison groups. Descriptive statistics and PSM models were computed to estimate the average treatment effect (ATE) and average treatment effect for the treated (ATET). All analyses were performed using Stata 16.1, and a p-value < 0.05 was deemed significant. RESULTS: Findings showed a significant positive impact of training on knowledge of malaria diagnosis and treatment (β = 0.052; 95% CI 0.006, 0.097; p = 0.03) and acceptability of the WHO test, treat, and refer guidelines among trained CPs and PPMVs (β = 0.432; 95% CI: 0.041, 0.822; p = 0.03). However, the training has no effect on compliance with treatment guidelines and identification of quality drugs. CONCLUSION: Malaria training using standard treatment guidelines modestly increases private providers' knowledge and acceptance. A scale-up of malaria training for CPs and PPMVs is recommended, and further research is needed on guideline compliance.

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