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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 (författare)
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Selling, Katarina Ekholm (författare)
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Nsona, Humphreys (författare)
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visa fler...
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Mappin, Bonnie (författare)
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Gething, Peter W. (författare)
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Petzold, Max (författare)
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Peterson, Stefan Swartling (författare)
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Hildenwall, Helena (författare)
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visa färre...
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(utgivare)
- 2016
- 2016
- Engelska.
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Ingår i: Malaria Journal. - 1475-2875. ; 15
Abstract
Ämnesord
Stäng
- 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.
Ämnesord
- Medical and Health Sciences (hsv)
- Health Sciences (hsv)
- Medicin och hälsovetenskap (hsv)
- Hälsovetenskaper (hsv)
Nyckelord
- Antibiotic resistance
- IMCI
- Malaria
- Diagnosis
- Child health
- Fever case management
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