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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
  1. 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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BMC Medicine

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