Table 1 Description of integrated paediatric fever management variables

Main complaints or danger signs

  Fever

During the exit interview, the caregiver is separately asked about each of the main symptoms or danger signs listed here

  Cough or difficult breathing (CDB)

  Watery or frequent stools

  Danger signs (any below):

    Lethargy or excessive sleepiness

    Vomits everything

    Convulsions

    Inability to drink, eat or breastfeed

  Ear problem

During the exit interview, the caregiver is subsequently asked about other reasons for bringing the child to this facility today and the response categories are listed here

  Eye problem

  Skin problem

  Other issue

Assessments

  Asked about or mentioned (insert complaint)

During the consultation, the interviewer silently records the performance of physical examinations. Those listed here are general assessments for presenting complaints of fever, cough or difficult breathing or diarrhea. Assessments reported in this paper are those based on Malawi IMCI algorithms unless otherwise noted^a

  Took the child’s temperature or felt body for hotness

  Counter respiration (breaths) for 60 s

  Checked skin turgor for dehydration

  Checked pallor by looking at palms^a

  Looked into the child’s mouth^a

  Checked for neck stiffness

  Undressed child (up to shoulders/down to ankles)^a

Classifications/diagnoses

  RDT-confirmed malaria

After the consultation, the provider is asked if a malaria RDT was conducted anywhere in the facility prior to coming into the consultation room that day and if so, the provider is asked to report the test result if seen

  IMCI-classified non-severe pneumonia

During the exit interview, there is a limited re-examination conducted by a trained provider that includes a 60-s respiratory rate count if cough or difficult breathing is present. IMCI-pneumonia classification (non-severe) is defined as reported cough or difficult breathing and a respiratory rate of 50 breaths or more per minute (2 up to 12 months) or 40 breaths or more per minute (12 months up to 5 years)

  Clinical diarrhoea

During the consultation, the following recorded diagnoses for diarrhea or dehydration are included in this definition: diarrhoea, dysentery, amoebiasis, other digestive/intestinal issue, mild dehydration, moderate dehydration or severe dehydration

Treatment prescriptions

  Anti-malarial prescriptions

After the consultation, the provider is asked to report treatments prescribed to the client and a hierarchical coding was used to assign the more appropriate prescription to the observation. First-line anti-malarial prescription is defined as artemether/artesunate (oral, injection or suppository) or ACT/AL (oral). Second-line is quinine (oral or injection), amodiaquine (oral), fansidar (oral) or other anti-malarial (oral or injection). Anti-malarial over-treatment is any anti-malarial prescription for an RDT-negative result

  Antibiotic prescriptions

After the consultation, the provider is asked to report treatments prescribed to the client and a hierarchical coding was used to assign the more appropriate prescription to the observation. First-line antibiotic prescription is defined as benzyl penicillin injection or amoxicillin (capsule or syrup). Second-line is cotrimoxazole (syrup or tablet) or other antibiotic (injection, syrup or capsule). Antibiotic over-treatment is the main outcome and is defined in the text

  ORS and zinc prescriptions

After the consultation, the provider is asked to report treatments prescribed to the client. ORS and zinc is defined as a prescription of zinc and [home ORT (plan A) or initial ORT in facility (plan B) or intravenous fluids (plan C)]