ArticleMalaria journal2016
Integrated paediatric fever management and antibiotic over-treatment in Malawi health facilities: data mining a national facility census.
Article in Malaria journal, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.
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Who cites it
27 citing papers in PubMed, 39 citations in OpenAlex.
- Impact of the Introduction of a Package of Diagnostic Tools, Diagnostic Algorithm, and Training and Communication on Outpatient Acute Fever Case Management at 3 Diverse Sites in Uganda: Results of a Randomized Controlled Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Trial
- Urine bioassay optimisation to assess the association between antimicrobial exposure, pneumococcal carriage and antimicrobial resistance among hospitalised children in Malawi.BMC infectious diseases · 2025Article
- Modeling pediatric antibiotic use in an area of declining malaria prevalence.Scientific reports · 2024Article
- Challenges in Diagnosing and Treating Acutely Febrile Children with Suspected Malaria at Health Care Facilities in the Lake Mwanza Region of Tanzania.The American journal of tropical medicine and hygiene · 2024Article
- Evaluation of Doctors' Knowledge, Attitudes, Behaviors, Awareness and Practices on Rational Antimicrobial Stewardship in a Training and Research Hospital in Mogadishu-Somalia.Infection and drug resistance · 2024Article
- The politics of irrationality.Medical anthropology quarterly · 2023Article
- Overuse of medications in low- and middle-income countries: a scoping review.Bulletin of the World Health Organization · 2023Article
- Dengue algorithms integrated into the IMCI guidelines: An updated assessment in five Southeast-Asian countries.PLoS neglected tropical diseases · 2022Article
- High Frequency of Antibiotic Prescription in Children With Undifferentiated Febrile Illness in Kenya.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Article
- Altered Mental Status Among Febrile Hospitalized HIV-Infected Children Aged 0-59 Months in Mozambique.Journal of tropical pediatrics · 2021Observational
- Inter-prescriber variability in the decision to prescribe antibiotics to febrile patients attending primary care in Myanmar.JAC-antimicrobial resistance · 2021Article
- Primary Care Case Management of Febrile Children: Insights From the ePOCT Routine Care Cohort in Dar es Salaam, Tanzania.Frontiers in pediatrics · 2021Article
- Trends in health workers' compliance with outpatient malaria case-management guidelines across malaria epidemiological zones in Kenya, 2010-2016.Malaria journal · 2020Article
- Prevalence and Clinical Management of Non-malarial Febrile Illnesses among Outpatients in the Era of Universal Malaria Testing in Malawi.The American journal of tropical medicine and hygiene · 2020Article
- Effect of Supportive Supervision on Competency of Febrile Clinical Case Management in Sub-Saharan Africa.The American journal of tropical medicine and hygiene · 2019Article
- Prescription of Antibacterial Drugs for HIV-Exposed, Uninfected Infants, Malawi, 2004-2010.Emerging infectious diseases · 2019Article
- Interventions to Reduce Antibiotic Prescribing in LMICs: A Scoping Review of Evidence from Human and Animal Health Systems.Antibiotics (Basel, Switzerland) · 2018Article
- Health systems thinking: A new generation of research to improve healthcare quality.PLoS medicine · 2018Article
- The epidemiology of febrile illness in sub-Saharan Africa: implications for diagnosis and management.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2018Review
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Authors and funding
8 authors at 6 institutions in 4 countries.
Funding
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.
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