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Table 4 Univariable and multivariable risk factors for parasite positivity on day 2

From: Clinical determinants of early parasitological response to ACTs in African patients with uncomplicated falciparum malaria: a literature review and meta-analysis of individual patient data

   

Univariable analysis

Multivariable analysisc

Variable

N (n)a

Random effectsb

Crude OR (95 % CI)

P value

Adjusted OR (95 % CI)

P value

Baseline parasitaemia (2-fold rise)

27,496 (1,853)

2.31

1.30 (1.26–1.34)

<0.001

1.27 (1.24–1.31)

<0.001

Baseline anaemia

      

Non-anaemic (reference)d

8,838 (544)

2.14

1

-

-

-

Moderate

9,652 (714)

 

1.07 (0.94–1.22)

0.274

1.07 (0.94–1.22)

0.289

Severe

1,668 (124)

 

1.24 (0.99–1.55)

0.056

1.33 (1.06–1.67)

0.014

Unknown

7,338 (471)

 

-

-

-

-

Gametocytes presence

      

No (reference)

18,672 (1,358)

2.08

1

-

-

-

Yes

1,979 (102)

 

0.95 (0.74–1.2)

0.650

-

-

Febrile on presentation (temperature >37.5 °C)

      

No (reference)

9,355 (433)

2.06

1

-

-

-

Yes

17,217 (1,412)

 

1.72 (1.52–1.95)

<0.001

1.46 (1.28–1.66)

<0.001

Gendere

      

Female (reference)

12,873 (835)

2.22

1

-

-

-

Male

13,995 (982)

 

1.11 (1.00–1.23)

0.052

-

-

Age category

      

≥12 years (reference)

4,245 (202)

2.22

1

-

-

-

<1 year

2,014 (139)

 

1.89 (1.40–2.57)

<0.001

1.49 (1.09–2.05)

0.013

1 to <5 years

15,677 (1,176)

 

1.94 (1.52–2.46)

<0.001

1.54 (1.21–1.97)

0.001

5 to <12 years

5,528 (334)

 

1.49 (1.20–1.85)

<0.001

1.25 (1.00–1.56)

0.048

Transmission settings

      

High (reference)

10,368 (455)

2.12

1

-

-

-

Low/moderate

17,128 (1,398)

 

1.50 (0.88–2.55)

0.135

1.88 (1.09–3.24)

0.024

Treatmentf

      

DP (reference)

4,420 (340)

2.12

1

-

-

-

AL

12,255 (729)

 

1.19 (1.00–1.42)

0.050

1.21 (1.01–1.44)

0.040

ASAQ-FDC

4,997 (246)

 

0.94 (0.75–1.19)

0.619

0.90 (0.71–1.14)

0.388

ASAQ-coblistered NFDC

1,574 (167)

 

1.80 (0.84–3.85)

0.130

1.87 (0.86–4.04)

0.113

ASAQ-loose NFDC

4,250 (371)

 

1.62 (1.18–2.22)

0.003

1.46 (1.05–2.01)

0.022

  1. aN, number of patients with non-missing data; n, number of patients with positive blood smear on day 2; bvariance of the random effects for the univariable analyses; cN = 26,544 for the final multivariable model with 1,843 cases of positive parasitaemia. Likelihood ratio test for random effect (P <0.001). Variance of random effect = 2.05. Proportion of total variance contributed by the site-level variance component (ρ) = 0.38. Coefficient (standard error) of intercept = −7.95 (0.3539). The coefficient of variation in parameter estimates was calculated by excluding one study site at a time and expressed as relative standard deviation (RSD). Distributions of the adjusted odds ratio (AOR) were generated from 250 bootstrap samples. The RSD and bootstrap distribution are shown in Additional file 4: Table S8 and Figure S3); dmultiple imputation was performed on missing anaemia status using ordinal logistic regression with age, gender and parasitaemia as covariates. The estimates derived using 100 imputations for moderate and severe anaemia are: AOR = 1.05 (95 % CI: 0.93–1.19), P = 0.446; and AOR = 1.24 (95 % CI: 0.99–1.55), P = 0.056, respectively; egender (AOR = 1.10 (95 % CI: 0.99–1.22), P = 0.079 using likelihood ratio test) was no longer significant in the presence of the other variables shown in the multivariable model and hence dropped; ffor AL compared to ASAQ-FDC (AOR = 1.33 (95 % CI: 1.08–1.63, P = 0.005). For ASAQ-loose NFDC compared to ASAQ-FDC (AOR = 1.61 (95 % CI: 1.14–2.29), P = 0.007). AL, artemether-lumefantrine; AS-AQ, artesunate-amodiaquine; ASAQ-coblistered NFDC, non-fixed dose combination in a co-blister formulation; ASAQ-FDC, fixed dose combination; ASAQ-loose NFDC, non-fixed dose combination in a loose formulation; DP, dihydroartemisinin-piperaquine