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Integrated paediatr...
Integrated paediatric fever management and antibiotic over-treatment in Malawi health facilities: data mining a national facility census
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- Johansson, Emily White (author)
- Uppsala universitet,Internationell mödra- och barnhälsovård (IMCH),Internationell barnhälsa och nutrition
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- Selling, Katarina Ekholm (author)
- Uppsala universitet,Internationell mödra- och barnhälsovård (IMCH),Internationell barnhälsa och nutrition
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- Nsona, H. (author)
- Minist Hlth, Integrated Management Childhood Illness IMCI Unit, Lilongwe, Malawi.,Malawi Ministry of Health
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- Mappin, B. (author)
- Univ Oxford, Dept Zool, Spatial Ecol & Epidemiol Grp, Oxford, England.,University of Oxford, Department of Zoology, Spatial Ecology and Epidemiology Group
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- Gething, P. W. (author)
- Univ Oxford, Dept Zool, Spatial Ecol & Epidemiol Grp, Oxford, England.,University of Oxford, Department of Zoology, Spatial Ecology and Epidemiology Group
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- Petzold, Max, 1973 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa, enheten för hälsometri,Institute of Medicine, Department of Public Health and Community Medicine, Health Metrics,Univ Gothenburg, Ctr Appl Biostat, Sahlgrenska Acad, Gothenburg, Sweden.,University of Gothenburg, The Sahlgrenska Academy, Center for Applied Biostatistics
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- Peterson, Stefan Swartling (author)
- Karolinska Institutet,Uppsala universitet,Internationell mödra- och barnhälsovård (IMCH),Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy Res Grp, Stockholm, Sweden.;Makerere Univ, Coll Hlth Sci, Sch Publ Hlth, Kampala, Uganda.,Internationell barnhälsa och nutrition,Global Health-Health Systems and Policy Research Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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- Hildenwall, H. (author)
- Karolinska Institutet,Karolinska Institutet, Global Health - Health Systems and Policy Research Group
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(creator_code:org_t)
- 2016-08-04
- 2016
- English.
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In: Malaria Journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 15
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Abstract
Subject headings
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- Background: There are growing concerns about irrational antibiotic prescription practices in the era of test-based malaria case management. This study assessed integrated paediatric fever management using malaria rapid diagnostic tests (RDT) and Integrated Management of Childhood Illness (IMCI) guidelines, including the relationship between RDT-negative results and antibiotic over-treatment in Malawi health facilities in 2013-2014. Methods: A Malawi national facility census included 1981 observed sick children aged 2-59 months with fever complaints. Weighted frequencies were tabulated for other complaints, assessments and prescriptions for RDT-confirmed malaria, IMCI-classified non-severe pneumonia, and clinical diarrhoea. Classification trees using model-based recursive partitioning estimated the association between RDT results and antibiotic over-treatment and learned the influence of 38 other input variables at patient-, provider- and facility-levels. Results: Among 1981 clients, 72 % were tested or referred for malaria diagnosis and 85 % with RDT-confirmed malaria were prescribed first-line anti-malarials. Twenty-eight percent with IMCI-pneumonia were not prescribed antibiotics (under-treatment) and 59 % 'without antibiotic need' were prescribed antibiotics (over-treatment). Few clients had respiratory rates counted to identify antibiotic need for IMCI-pneumonia (18 %). RDT-negative children had 16.8 (95 % CI 8.6-32.7) times higher antibiotic over-treatment odds compared to RDT-positive cases conditioned by cough or difficult breathing complaints. Conclusions: Integrated paediatric fever management was sub-optimal for completed assessments and antibiotic targeting despite common compliance to malaria treatment guidelines. RDT-negative results were strongly associated with antibiotic over-treatment conditioned by cough or difficult breathing complaints. A shift from malaria-focused 'test and treat' strategies toward 'IMCI with testing' is needed to improve quality fever care and rational use of both anti-malarials and antibiotics in line with recent global commitments to combat resistance.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)
Keyword
- Antibiotic resistance
- IMCI
- Malaria
- Diagnosis
- Child health
- Fever case management
- childhood illness
- central vietnam
- malaria control
- risk-factors
- children
- pneumonia
- quality
- africa
- care
- Infectious Diseases
- Parasitology
- Tropical Medicine
- Antibiotic resistance
Publication and Content Type
- ref (subject category)
- art (subject category)
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