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Table 4 Association of endemicity and age with non-prescription of ACT among mRDT-positive patients

From: Patients with positive malaria tests not given artemisinin-based combination therapies: a research synthesis describing under-prescription of antimalarial medicines in Africa

Project sitemRDT positivityAge (years)Number (%) of mRDT-positive patients not prescribed ACT by proxy endemicity setting*UnadjustedAdjusted
OR95% CIp valueOR95% CIp value
(i) Effect of endemicity setting on ACT non-prescription in baseline age group (< 5 years)
 Nige1High< 595/399 (23.8)1.00Ref.0.0041.00Ref.0.077
Mod–high62/134 (46.3)2.761.39, 5.451.980.93, 4.22
 Tanz1Mod–high< 547/173 (27.2)1.00Ref.0.0261.00Ref.0.027
Low41/64 (64.1)4.781.21, 18.934.801.19, 19.34
 Tanz2Mod–low< 5770/4102 (18.8)1.00Ref.0.0011.00Ref.< 0.001
Low177/294 (60.2)6.552.88, 14.856.222.70, 14.35
 Uga2§Mod–high< 146/3364 (1.4)1.00Ref.< 0.0011.00Ref.< 0.001
Low11/35 (31.4)33.111.88, 92.0032.4911.36, 92.92
(ii) Effect of age on ACT non-prescription in differing areas of endemicity
 Nige1High< 510/26 (38.5)1.00Ref.0.0521.00Ref.0.051
≥ 585/373 (22.8)0.470.22, 1.010.470.22, 1.00
Mod–high< 56/16 (37.5)
≥ 556/118 (47.5)
 Tanz1Mod–high< 534/110 (30.9)1.00Ref.0.2261.00Ref.0.221
≥ 513/63 (20.6)0.580.24, 1.400.580.24, 1.39
Low< 530/43 (69.8)1.00Ref.0.1321.00Ref.0.124
≥ 511/21 (52.4)0.480.18, 1.250.470.18, 1.23
 Tanz2Mod–high< 5212/1429 (14.8)1.00Ref.< 0.0011.00Ref.< 0.001
≥ 5558/2673 (20.9)1.511.23, 1.861.511.23, 1.86
Low< 535/51 (68.6)1.00Ref.0.1171.00Ref.0.109
≥ 5142/243 (58.4)0.640.37, 1.120.670.43, 1.09
 Uga2§Mod–high< 110/238 (4.2)1.00Ref.0.0121.00Ref.0.013
≥ 136/3104 (1.2)0.270.10, 0.750.270.09, 0.75
Low< 11/4 (25.0)
≥ 110/31 (32.3)
  1. *n is number of patients per study site not prescribed ACT among all mRDT-positive patients with complete data for age, gender, endemicity setting, sector, and intervention arm. Total number of mRDT-positive patients not prescribed ACT: N = 7291/104,454
  2. All adjusted models included age and gender as a priori variables and where sufficient data available (≥ 10 outcomes per cell), plus all other variables found significant by univariate analyses (p < 0.05). Statistical models for each site vary in composition due to differences in study designs. Final regression models for each site include the following variables: Nige1—gender, age, sector, and endemicity; Tanz1—gender, age, and endemicity setting; Tanz2—gender, age, and endemicity setting; Uga2—gender, age, and endemicity setting; Nige1 (high)—gender and age; Tanz1 (mod–high)—gender and age; Tanz1 (low)—gender and age; Tanz2 (mod–high)—gender and age; Tanz2 (low)—gender, age, and intervention arm; and Uga2 (mod–high)—gender and age. Nige1 (mod–high) and Uga2 (low) had insufficient outcomes in binary age categories to undergo analysis
  3. Confidence intervals and p value calculated using Wald’s test
  4. §Uga2 age categories </≥ 1 due to primary study limited to patients aged under 6 years
  5. Analysis not undertaken due to insufficient number of outcomes