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

Författare och institution:
E. W. Johansson (-); K. E. Selling (-); H. Nsona (-); B. Mappin (-); P. W. Gething (-); Max Petzold (Hälsometri); S. S. Peterson (-); H. Hildenwall (-)
Publicerad i:
Malaria Journal, 15
Artikel, refereegranskad vetenskaplig
Sammanfattning (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.
Ämne (baseras på Högskoleverkets indelning av forskningsämnen):
Antibiotic resistance, IMCI, Malaria, Diagnosis, Child health, Fever case management, childhood illness, central vietnam, malaria control, risk-factors, children, pneumonia, quality, africa, care, Infectious Diseases, Parasitology, Tropical Medicine
Postens nummer:
Posten skapad:
2016-09-02 09:12

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