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Table 6 Quality of malariaa treatment in outpatient health facilities, Huambo Province, Angola

From: Quality of malaria case management at outpatient health facilities in Angola

Characteristic and patient sub-group No. and weighted percentage of patients
  n % (95% CI)
Quality of malaria treatment among all 177 patients b    
   Correct (recommended treatment) 105 61.4 (52.0-70.7)
   Minor error 42 22.3 (12.3-32.3)
   Major error 30 16.3 (10.2-22.4)
Quality of malaria treatment among the 59 patients with malaria b    
   Correct (recommended treatment) 27 49.0 (33.5-64.5)
   Minor errorc 2 5.4 (0-13.2)
   Major errord 30 45.6 (28.2-63.1)
Quality of malaria treatment for the 59 malaria cases (quality in terms of antimalarials obtained by patients and patient recall of treatment instructions)    
   Patient left the health facility with the recommended anti-malarial and knowledge of how to administer the drug at home 17 27.1 (14.8-39.4)
   Patient left the health facility with an adequate (but not recommended) anti-malarial and knowledge of how to administer the drug at home 2 5.4 (0-13.2)
   Patient left the health facility without at least one of the following: an effective anti-malarial or adequate knowledge of how to administer the drug at home 40 67.5 (53.6-81.5)
Quality of malaria treatment among the 118 patients without malaria b    
   Correct (recommended treatment) 78 68.3 (54.6-82.0)
   Minor error 40 31.7 (18.0-45.4)
  1. AL = artemether-lumefantrine; CI = confidence interval.
  2. a The "gold standard" malaria diagnosis (against which health worker treatments were compared) was defined by applying the analysis algorithm (Figure 1) to patient clinical signs and symptoms (assessed by surveyors, but information that should have been available to observed health workers) and laboratory data available to observed health workers (i.e., not the survey team's laboratory results).
  3. b Quality in terms of anti-malarials prescribed by health workers. No error means that patients received recommended treatment in exact accordance with guidelines (malaria cases treated with the recommended anti-malarial with the recommended dosage, and non-malaria cases received no anti-malarial treatment). Minor error means that malaria cases received non-recommended, but still life-saving, anti-malarial treatment (either an overdose of a recommended anti-malarial, or an adequate dose of a non-recommended anti-malarial); and non-malaria cases received unnecessary anti-malarial treatment that was unlikely to cause serious harm. Major error means that malaria cases did not receive life-saving treatment (no anti-malarial, an ineffective anti-malarial, or an under-dosed anti-malarial).
  4. c The 2 minor errors were: 1 case of uncomplicated malaria treated with correctly dosed quinine, and 1 case of uncomplicated malaria in a child < 5 kg treated with AL (with a dosage appropriate for a child 5-14 kg).
  5. d The 30 major errors were: 26 cases of uncomplicated malaria not treated with anti-malarials, 2 cases of uncomplicated malaria treated with ineffective anti-malarials (1 treated with amodiaquine, 1 treated with sulfadoxine-pyrimethamine), 1 case of uncomplicated malaria treated with underdosed AL, and 1 case of complicated malaria treated with underdosed AL.