Can Individuals’ Beliefs Help Us Understand Non-Adherence to Malaria Test Results? Evidence from Rural Kenya

In malaria-endemic countries about a quarter of test-negative individuals take antimalarials (artemisinin-based combination therapies, ACTs). ACT overuse depletes scarce resources for subsidies and contributes to parasite resistance. As part of an experiment in Kenya that provided subsidies for rapid diagnostic test and/or for ACT conditionally on being positive, we study the relationship between beliefs on malaria status (prior and posterior the intervention), and the decisions to get tested and to purchase ACT. We find that prior beliefs do not explain the decision of getting tested (conditional on the price) and non-adherence to a negative test. However, test-negative individuals who purchase ACT report higher posterior beliefs than those who do not, consistent with a framework in which the formers revise beliefs upward, while the latters do not change or revise downward. Further research is needed to improve adherence to malaria-negative test results.