Patient-, health worker-, and health facility-level determinants of correct malaria case management at publicly funded health facilities in Malawi: results from a nationally representative health facility survey

Table 2 Patient demographics, clinical characteristics and clinician assessment and treatment, percentage

	Patient age
	<5 years %	5+ years %	p-value	Total %
	*n=806*	*n=1209*		*n=2019*
Demographics
Age in years, Mean (range)	1.9 (0.0, 5.0)	28.5 (5.0, 86.4)	–	18.4 (0.0, 86.4)
Male	51.4	37.8	<0.0001	42.9
Clinical presentation
High temperature (≥37.5°C) during exit interview	38.7	21.2	<0.0001	27.8
Presented with an illness involving a fever*	94.1	81.8	<0.0001	86.5
Positive exit interview blood smear (BS)	45.8	28.7	0.001	35.2
Uncomplicated malaria prevalence (fever and positive BS)	45.5	27.0	0.001	34.0
Spontaneously complained to health worker about:
Fever	79.7	40.1	<0.0001	55.1
Cough	56.2	30.0	<0.0001	40.0
Vomiting	20.8	8.3	<0.0001	13.1
Chills	5.6	13.9	<0.0001	10.7
Fatigue	5.7	1.0	<0.0001	3.7
Health worker assessment of fever
Asked patient about fever^¶	46.9	31.6	0.028	34.2
Took temperature^†	19.5	7.0	0.001	9.1
Did not ask about fever or take temperature (and fever not reported by patient)	9.2	39.0	<0.0001	27.7
Correct diagnosis and treatment of patients with confirmed malaria (according to exit interview BS)	n=269	n=358		*n=629*
Health worker diagnosis of malaria	79.8	66.6	0.031	73.2
Correct treatment^¥	72.7	61.5	0.066	67.1
Overtreatment of patients without confirmed malaria	n=537	n=851		*n=1,390*
Health worker diagnosis of malaria	44.0	31.5	0.069	35.3
ACT prescription^¥	43.8	24.9	0.001	30.9

Note: data are weighted except for age ranges (unweighted).
*Includes positive responses for: 1) patient says illness involved a fever; 2) patient spontaneously mentioned fever complaint to health worker; 3) patient reported a symptom of fever to surveyor when probed, or temperature on re-examination was >=37.5°C.
^¶If patient does not spontaneously report to health worker.
^†If patient does not spontaneously report fever and health worker does not ask about fever.
^¥ACT for most patients, or oral quinine for pregnant women in their first trimester or patients weighing less than 5 kg.

ISSN: 1475-2875