Format

Send to

Choose Destination
Malar J. 2016 Aug 4;15(1):396. doi: 10.1186/s12936-016-1439-7.

Integrated paediatric fever management and antibiotic over-treatment in Malawi health facilities: data mining a national facility census.

Author information

1
Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden. emily.johansson@kbh.uu.se.
2
Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.
3
Integrated Management of Childhood Illness (IMCI) Unit, Ministry of Health, Lilongwe, Malawi.
4
Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, UK.
5
The Sahlgrenska Academy, Center for Applied Biostatistics, University of Gothenburg, Gothenburg, Sweden.
6
Global Health-Health Systems and Policy Research Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
7
School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

Abstract

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.

KEYWORDS:

Antibiotic resistance; Child health; Diagnosis; Fever case management; IMCI; Malaria

PMID:
27488343
PMCID:
PMC4972956
DOI:
10.1186/s12936-016-1439-7
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center