Table 2 An example of content thematic analysis

Evidence used was mainly on the efficacy of the drugs being used (CQ/SP) and there was good quality evidence from different sites in the country showing that the efficacy of the drugs was declining.

Evidence used was mainly on the efficacy of the drugs

Efficacy studies of high quality from multiple sites showing consistent results

High-quality evidence of drug efficacy (CQ/SP)

Characteristics of available evidence

Good evidence from different sites in the country

Though few studies has been done in Uganda, there were studies in other countries in the region- Ghana, Zambia- showing high levels of efficacy for the ACTs in a similar environment. The evidence from the clinical studies was quite good- the studies were comparable and had been done with adequate sample sizes. The data were consistently showing increasing resistance.

High-quality evidence showed a high level of efficacy for the ACTs in other similar settings

A lot of international evidence on efficacy was used, including sentinel surveillance sites set up by EAMAT, who are respected professionals.

Evidence from MoH-owned sentinel studies supported by respected researchers

There was not overwhelming data in the country to compare the two (CQ/SP & ACTs); but real data was available showing that CQ was failing. Just a few studies compared ACTs, but the particular ACTs being used and that were recommended as the best for the circumstances had only been investigated by one study in Uganda.

Real data showing CQ was failing

There was also the option of taking amodiaquine artesunate and artemether lumefantrine. A few studies investigated artesunate, but studies with amodiaquine showed that amodiaquine resistance was not yet at the mark where it cannot be used, especially if it is in combination with SP, but the resistance of amodiaquine was increasing rapidly. Then the issue was that, if combination therapy is used and amodiaquine loses efficacy in the next one to two years, the problem of mono therapy will return.

Efficacy data was available on the different options: amodiaquine artesunate and artemether lumefantrine

Locally available evidence on drug efficacy study discussed in a stakeholder forum

Locally available evidence of the efficacy of other potential drugs/ACTs was reviewed and discussed

As a country, none of the partners involved in implementing malaria control activities disagreed with the results on CQ resistance that came out of the studies.

All partners agreed with research results

Consensus on research results