Prescriber and patient-oriented behavioural interventions to improve use of malaria rapid diagnostic tests in Tanzania: facility-based cluster randomised trial

Cundill, Bonnie; Mbakilwa, Hilda; Chandler, Clare IR; Mtove, George; Mtei, Frank; Willetts, Annie; Foster, Emily; Muro, Florida; Mwinyishehe, Rahim; Mandike, Renata; Olomi, Raimos; Whitty, Christopher JM; Reyburn, Hugh

doi:10.1186/s12916-015-0346-z

Table 5 Effect of interventions on antimalarial prescribing, RDT use and antibiotic prescribing

From: Prescriber and patient-oriented behavioural interventions to improve use of malaria rapid diagnostic tests in Tanzania: facility-based cluster randomised trial

Outcome	Arm	Number of patients	Prevalence number (%)	Crude RD ^a (95% CI)	Adjusted RD ^b (95% CI)	P -value
Patients with fever treated with rAM	Control	9,231	2180 (24%)	0	0
	HW	9,752	1700 (17%)	0.07 (0.004, 0.13)	0.03 (−0.04, 0.10)	0.44
	HWP	7,887	1304 (16%)	0.07 (0.01, 0.14)	0.05 (−0.002, 0.10)	0.06
Patients with no fever treated with rAM	Control	4,863	82 (2%)	0	0
	HW	6,062	193 (3%)	−0.003 (−0.02, 0.01)	0.002 (−0.01, 0.01)	0.52
	HWP	5,984	40 (1%)	0.01 (−0.01, 0.03)	0.002 (−0.01, 0.01)	0.73
RDT uptake
Patients with fever tested with RDT	Control	9,297	4960 (53%)	0	0
	HW	9,825	5374 (55%)	−0.04 (−0.15, 0.07)	−0.04 (−0.20, 0.10)	0.57
	HWP	7,963	5153 (65%)	−0.12 (−0.21, −0.03)	−0.02 (−0.13, 0.09)	0.72
RDT eligible (fever and no obvious alternate diagnosis) not tested	Control	8,241	3697 (45%)	0	0
	HW	9,064	4000 (44%)	0.04 (−0.07, 0.15)	0.06 (−0.11, 0.23)	0.44
	HWP	7,292	2459 (34%)	0.12 (0.04, 0.21)	0.18 (0.05, 0.32)	0.01
RDT ineligible (no fever) tested	Control	4,874	587 (12%)	0	0
	HW	6,083	955 (16%)	−0.01 (−0.07, 0.04)	0.01 (−0.06, 0.07)	0.86
	HWP	6,000	518 (9%)	0.02 (−0.05, 0.09)	0.02 (−0.04, 0.09)	0.43
Presumptive treatment
RDT eligible treated presumptively for malaria	Control	8,241	471 (6%)	0	0
	HW	9,064	374 (4%)	0.02 (−0.01, 0.05)	0.01 (−0.02, 0.04)	0.40
	HWP	7,292	256 (4%)	0.02 (−0.003, 0.05)	0.02 (−0.004, 0.05)	0.09
RDT ineligible treated presumptively for malaria	Control	4,874	42 (1%)	0	0
	HW	6,083	47 (1%)	0.004 (−0.001, 0.01)	0.003 (−0.001, 0.01)	0.15
	HWP	6,000	12 (0.2%)	0.007 (0.003, 0.01)	0.004 (−0.0001, 0.01)	0.05
Adherence to RDT negative
RDT negative receiving AM	Control	4,015	762 (19%)	0	0
	HW	4,539	250 (6%)	0.14 (0.08, 0.20)	0.10 (0.03, 0.17)	0.01
	HWP	4,330	189 (4%)	0.15 (0.09, 0.21)	0.10 (0.04, 0.16)	0.002
RDT negative receiving AM (among those with fever)	Control	3,488	723 (21%)	0	0
	HW	3,793	235 (6%)	0.16 (0.08, 0.23)	0.11 (0.03, 0.19)	0.01
	HWP	3,897	177 (5%)	0.21 (0.04, 0.17)	0.12 (0.05, 0.19)	0.002
RDT negative receiving AM (among those with no fever)	Control	527	39 (7%)	0	0
	HW	746	15 (2%)	0.05 (−0.01, 0.10)	0.03 (0.01 0.05)	0.004
	HWP	433	12 (3%)	0.04 (−0.01, 0.10)	-	-
Adherence to RDT positive
RDT positive receiving rAM	Control	1,455	1166 (80%)	0	0
	HW	1,696	1402 (83%)	−0.10 (−0.35, 0.15)	−0.13 (−0.45, 0.19)	0.39
	HWP	1,249	963 (77%)	−0.17 (−0.41, 0.06)	−0.04 (−0.25, 0.17)	0.69
RDT positive receiving rAM (among those with fever)	Control	1,406	1149 (82%)	0	0
	HW	1,508	1255 (83%)	−0.07 (−0.31, 0.18)	−0.11 (−0.44, 0.22)	0.49
	HWP	1,180	942 (79%)	−0.14 (−0.37, 0.09)	−0.01 (−0.23, 0.21)	0.89
RDT positive receiving rAM (among those without fever)	Control	49	17 (35%)
	HW	188	147 (78%)	-	-
	HWP	69	21 (30%)	-	-
Treatment with antibiotics
Non-malarial illness receiving ABx	Control	8,942	6865 (77%)	0	0
	HW	10,118	7886 (78%)	0.01 (−0.09, 0.12)	0.02 (−0.22, 0.24)	0.89
	HWP	10,163	7525 (74%)	0.01 (−0.04, 0.07)	0.14 (−0.01, 0.29)	0.06
RDT negative receiving ABx	Control	4,015	2977 (74%)	0	0
	HW	4,539	3527 (78%)	−0.02 (−0.12, 0.09)	0.003 (−0.23, 0.24)	0.98
	HWP	4,330	3236 (75%)	−0.004 (−0.07, 0.06)	0.13 (−0.02, 0.27)	0.08
RDT eligible receiving ABx	Control	8,241	5731 (70%)	0	0
	HW	9,064	6808 (75%)	−0.03 (−0.13, 0.07)	0.01 (−0.21, 0.25)	0.89
	HWP	7,292	4,994 (68%)	0.01 (−0.09, 0.10)	0.13 (−0.03, 0.30)	0.09
RDT ineligible receiving ABx	Control	4,863	3774 (78%)	0	0
	HW	6,062	4531 (75%)	0.07 (−0.07, 0.20)	0.03 (−0.21, 0.28)	0.77
	HWP	5,984	4334 (72%)	0.04 (−0.02, 0.10)	0.15 (0.01, 0.30)	0.04

^aAdjusted for stratification; effect estimate is risk difference = control – intervention; control is standard RDT training. ^bAdjusted for facility (stock-out of ACT, stratum, provision of materials), prescriber (age, education, time at facility) and patient (age) characteristics. Treatment outcomes additionally adjusted for facility-level proportion treated with recommended antimalarial (rAM)/any antimalarial (AM) at baseline. Insufficient clusters per stratum and cluster size to conduct a robust analysis. Number of clusters is 12 per arm for all outcomes. ACT, artemisinin-based combination therapies; AM, antimalarial; CI, confidence interval; HW, health worker; HWP, health worker plus patient-oriented; rAM, recommended antimalarial; RD, risk difference; RDT, rapid diagnostic test; SMS, mobile-phone text message.

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