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Effect of Point-of-Care Diagnostic Testing on Turnaround Time for Malaria Diagnosis in Nigerian Health Facilities

Abstract

Malaria remains a major public health problem in Nigeria, with timely diagnosis being essential for appropriate treatment and effective malaria case management. Delays in obtaining malaria test results may postpone treatment initiation, prolong patient waiting time, increase unnecessary empirical treatment, and place additional pressure on healthcare facilities. Conventional laboratory-based diagnostic procedures may involve challenges related to specimen transportation, laboratory workload, equipment availability, staffing, and processing time, particularly in health facilities with limited diagnostic resources. Point-of-care diagnostic testing provides an opportunity to perform malaria testing close to the patient and obtain results rapidly, thereby potentially reducing the time required to confirm malaria infection and initiate appropriate treatment. Against this background, this study investigates the effect of point-of-care diagnostic testing on turnaround time for malaria diagnosis in Nigerian health facilities. The study will be anchored on the Donabedian Model of Healthcare Quality, Health Systems Framework, and Diffusion of Innovations Theory. The Donabedian Model explains how healthcare structures, processes, and outcomes interact to influence quality of care, with diagnostic technology representing an important structural component and turnaround time representing a measurable process indicator. The Health Systems Framework emphasizes service delivery, health workforce, medical technologies, health information, financing, and infrastructure as important components of effective diagnostic services. Diffusion of Innovations Theory explains the adoption and implementation of new diagnostic technologies within healthcare facilities and how perceived advantages, compatibility, and organizational factors may influence their use. Collectively, these theoretical perspectives provide a suitable framework for explaining how point-of-care diagnostic testing may influence turnaround time for malaria diagnosis in Nigerian health facilities. The study will adopt a quantitative quasi-experimental or analytical comparative research design. The study population will comprise patients presenting with suspected malaria and healthcare workers involved in malaria diagnosis in selected public and private health facilities across Nigeria. A multistage sampling technique will be used to select states, local government areas, health facilities, departments, and eligible patients. Point-of-care diagnostic testing will be assessed using indicators such as availability of point-of-care malaria diagnostic devices, frequency of use, accessibility at the point of patient care, test availability during operating hours, healthcare-worker training, device functionality, availability of test materials, adherence to testing procedures, and integration of test results into clinical decision-making. Turnaround time for malaria diagnosis will be measured using indicators such as time from patient registration or sample collection to availability of malaria test results, median diagnostic turnaround time, proportion of tests completed within a specified period, waiting time for test results, and time from testing to initiation of appropriate treatment where applicable. Data will be collected using structured questionnaires, patient records, laboratory registers, diagnostic logs, point-of-care testing records, timestamps from facility information systems where available, and direct observation of diagnostic processes. Descriptive statistics will be used to summarize patient characteristics, diagnostic procedures, point-of-care testing availability, and turnaround-time patterns. Inferential statistical techniques, including chi-square tests, t-tests, Mann-Whitney U tests, correlation analysis, and multiple regression analysis where appropriate, will be used to determine the effect of point-of-care diagnostic testing on malaria diagnostic turnaround time. Where a quasi-experimental design is adopted, turnaround times before and after implementation of point-of-care testing or between facilities using point-of-care and conventional diagnostic approaches may be compared. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that point-of-care diagnostic testing has a significant positive effect on the timeliness of malaria diagnosis in Nigerian health facilities by reducing diagnostic turnaround time. Patients tested using point-of-care diagnostic methods are expected to receive malaria test results more rapidly than patients relying on conventional laboratory-based diagnostic procedures. Reduced turnaround time may facilitate earlier clinical decision-making, timely initiation of appropriate antimalarial treatment, reduced patient waiting periods, and improved utilization of healthcare resources. Point-of-care testing may be particularly valuable in primary healthcare facilities and other settings where laboratory infrastructure and personnel are limited. However, equipment breakdowns, inadequate supplies, insufficient healthcare-worker training, quality-control challenges, inconsistent power supply, procurement difficulties, and poor maintenance systems may limit the effectiveness of point-of-care diagnostic services. The study therefore expects accessible, reliable, properly maintained, and appropriately implemented point-of-care malaria diagnostic testing to contribute significantly to reducing diagnostic turnaround time in Nigerian health facilities. The study is expected to contribute to the literature on point-of-care diagnostic testing, malaria diagnosis, diagnostic turnaround time, malaria case management, laboratory services, healthcare quality, diagnostic technologies, primary healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Malaria Elimination Programme, National Primary Health Care Development Agency, state ministries of health, healthcare facility managers, laboratory professionals, clinicians, development partners, and policymakers regarding strategies for improving the timeliness of malaria diagnosis. The study will also provide evidence-based recommendations for expanding access to point-of-care malaria diagnostic technologies, strengthening healthcare-worker training, ensuring consistent availability of testing supplies, improving equipment maintenance and quality assurance, integrating point-of-care testing into routine malaria case management, and developing sustainable diagnostic systems that support timely and accurate malaria diagnosis across Nigerian health facilities.

Keywords: Point-of-care diagnostic testing, malaria diagnosis, turnaround time, malaria testing, diagnostic services, malaria case management, healthcare facilities, diagnostic technology, primary healthcare, Nigeria, public health.