Malaria diagnosis practices in formal private drug retail shops in the Ho Municipality, Ghana: a cross-sectional survey

Private drug retail outlets, including community pharmacies and over the counter medicine sellers (OTCMS), play a major role in malaria case management in Ghana. Appropriate diagnosis before treatment is essential for effective malaria control. Evidence on the availability and use of malaria diagnostic services in these outlets remains limited in many municipalities. This study assessed the current diagnostic practices and challenges of malaria diagnosis in formal private drug retail shops in the Ho Municipality, Ghana. A cross-sectional descriptive survey was conducted in selected formal private drug retail shops in the Ho Municipality, Volta Region, Ghana. Data were collected through phone interviews using structured questionnaires with the attendants and frontline staff of private drug retail shops. The study sample comprised 86 formal private drug retail shops, including both OTMS and Community Pharmacies. Information covered socio-demographic characteristics, availability and type of malaria diagnostic tests, training in malaria diagnosis, cost of testing, and respondents’ views on malaria diagnosis. Data were summarized using frequencies and percentages. Of the 86 facilities surveyed, 70 (81.4%) were OTCMS and 16 (18.6%) were pharmacies. Most respondents were aged 46 to 60 years (38.4%) and slightly more were male (51.2%). Malaria testing capacity was limited. Only 33 (38.4%) facilities had the diagnostic capacity for malaria, while 53 (61.6%) had no testing capability. All community pharmacies had malaria testing capacity compared with 24.2% of OTCMS. Testing before treatment was routinely practiced in only 11.6% of facilities, while 61.6% never tested before treatment. Rapid diagnostic tests (RDTs) were the only diagnostic method available, and microscopy was not used in any shop. Among facilities that stocked RDTs, common types included HRP2 antigen tests and HRP2/pLDH combination kits. Most respondents (76.7%) had received training in malaria diagnosis, mainly organized by the Pharmacy Council. Malaria testing typically cost between USD 0.98 and USD 1.63 in most facilities offering the service. Concerns raised by respondents included perceived inconsistency between test results and clinical judgement, the relatively high cost of test kits, and the need for stronger public education on malaria diagnostic guidelines. Malaria diagnostic services remain limited in formal private drug retail shops in the Ho Municipality, particularly among OTCMS. Although most staff have received training, routine testing before treatment is uncommon and many facilities lack diagnostic capacity. Strengthening access to rapid diagnostic tests, improving adherence to test before treat guidelines, and subsidizing test kits could improve malaria case management in these shops.