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Reference: Johansson, EW, Selling, KE, Nsona, H et al., (2016). Integrated paediatric fever management and antibiotic over-treatment in Malawi health facilities: data mining a national facility census. Malaria Journal, 15 (1), 396.Citable link to this page:

 

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

Abstract: BackgroundThere 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.MethodsA 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.ResultsAmong 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.ConclusionsIntegrated 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.

Publication status:PublishedPeer Review status:Peer reviewedVersion:Publisher's versionDate of acceptance:2016-07-11 Funder: Uppsala University   Funder: Karolinska Institutet   Funder: Swedish Research Council   Funder: European Commission   Funder: Malawi Ministry of Health   Funder: University of Gothenburg   Notes:© 2016 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Bibliographic Details

Publisher: BioMed Central

Publisher Website: http://www.biomedcentral.com/

Journal: Malaria Journalsee more from them

Publication Website: http://malariajournal.biomedcentral.com/

Volume: 15

Issue: 1

Extent: 396

Issue Date: 2016-08

pages:396Identifiers

Doi: https://doi.org/10.1186/s12936-016-1439-7

Issn: 1475-2875

Uuid: uuid:e02467df-3aa7-43a5-8187-954930ef11cd

Urn: uri:e02467df-3aa7-43a5-8187-954930ef11cd

Pubs-id: pubs:646239 Item Description

Type: journal-article;

Language: eng

Version: Publisher's versionKeywords: Antibiotic resistance Child health Diagnosis Fever case management IMCI Malaria

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Autor: Johansson, EW - - - Selling, KE - - - Nsona, H - - - Mappin, B - - - Gething, PW - facultyOxford, MSD, NDM, Human Genetics Wt Cen

Fuente: https://ora.ox.ac.uk/objects/uuid:e02467df-3aa7-43a5-8187-954930ef11cd



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