Background: The purpose of this study was to examine malaria testing practices and preferences in Bo, Sierra
Leone, and to ascertain interest in and willingness to take a home-based rapid diagnostic test administered by
a community health volunteer (CHV) or a trained family member rather than travelling to a clinical facility for
laboratory-based testing.
Methods: A population-based, cross-sectional survey of 667 randomly-sampled rural households and 157 urban
households was conducted in December 2013 and January 2014.
Results: Among rural residents, 69% preferred a self/family- or CHV-conducted home-based malaria test and 20%
preferred a laboratory-based test (with others indicating no preference). Among urban residents, these numbers were
38% and 44%, respectively. If offered a home-based test, 28% of rural residents would prefer a self/family-conducted
test and 68% would prefer a CHV-assisted test. For urban residents, these numbers were 21% and 77%. In total, 36% of
rural and 63% of urban residents reported usually taking a diagnostic test to confirm suspected malaria. The most
common reasons for not seeking malaria testing were the cost of testing, waiting to see if the fever resolved on its
own, and not wanting to travel to a clinical facility for a test. In total, 32% of rural and 27% of urban participants were
very confident they could perform a malaria test on themselves or a family member without assistance, 50% of rural
and 62% of urban participants were very confident they could perform a test after training, and 56% of rural and 33%
of urban participants said they would pay more for a home-based test than a laboratory-based test.
Conclusion: Expanding community case management of malaria to include home testing by CHVs and family
members may increase the proportion of individuals with febrile illnesses who confirm a positive diagnosis prior to
initiating treatment.