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

Table 4 Anti-malarial and antibiotic prescriptions for clients with fever complaints, Malawi health facilities, 2013–2014

	N	% prescribed treatment (95% CI)
Fever complaint	1981
RDT done prior to consultation or referral for malaria diagnosis	1426
RDT done prior to consultation with result reported	746
RDT-positive result	312
First-line anti-malarial prescription	265	85.1 (77.5–90.4)
Second-line anti-malarial prescription	22	7.0 (4.4–10.8)
No anti-malarial prescription	25	7.9 (3.6–16.7)
RDT-negative result	434
Any anti-malarial prescription (over-treatment)	44	10.2 (6.8–14.9)
IMCI pneumonia assessment with result reported	1367
IMCI pneumonia (non-severe) positive classification	376
First-line antibiotic prescription	148	39.4 (32.3–46.9)
Second-line antibiotic prescription	123	32.7 (26.3–39.8)
No antibiotic prescription	105	27.9 (20.7–36.5)
‘Without antibiotic need’	1411
Any antibiotic prescription (over-treatment)	830	58.8 (55.1–62.4)

Table 1 defines assessments and treatments reported in the above table. Anti-malarial under-treatment is defined as no anti-malarial prescription for an RDT-positive result. Anti-malarial over-treatment is defined as any anti-malarial prescription for an RDT-negative result. Antibiotic under-treatment is defined as no antibiotic prescription for a positive IMCI pneumonia classification. Antibiotic over-treatment is defined as any antibiotic prescription ‘without antibiotic need’, which excludes clients with IMCI-pneumonia based on re-examination and additionally excludes clients given the following diagnoses during the consultation: sepsis, acute ear infection, mastoiditis, dysentery, abscess, or severe malnutrition

ISSN: 1475-2875