Table 4 Descriptive typology of plausible explanations for quantitative results in six countries

DHS 2010-2011

DHS 2011

DHS 2010

DHS 2011-2012

DHS 2011

DHS 2010-2011

Outcomes (see Table 2 )

AOR (any anti-malarial use)

0.83 (0.48-1.44)

1.24 (0.96-1.61)

1.34 (1.11-1.61)

1.65 (0.92-2.98)

2.79 (1.92-4.05)

3.71 (2.63-5.25)

AOR (ACT use)

0.88 (0.51-1.51)

0.84 (0.66-1.06)

1.12 (0.94-1.34)

1.96 (0.91-4.19)

3.54 (2.33-5.39)

2.78 (1.81-4.27)

AOR (any antibiotic use)

2.95 (1.82-4.79)

1.37 (1.09-1.72)

1.00 (0.82-1.22)

1.15 (0.64-2.08)

1.01 (0.64-1.59)

0.53 (0.40-0.72)

Available diagnostics and medicines

National ACT scale-up initiated

Yes

Yes

Yes

Yes

Yes

Yes

National RDT scale-up initiated

Yes

No

No

Yes

Yes

No

Reported inconsistent RDT supplies

No

N/A

N/A

Mixed reports [9,44]

Yes

N/A

Reported inconsistent ACT supplies

No

Yes

No [20]

Yes

Yes

Yes

Diagnostics at community-level

Yes [61]

No

No

No

No

No

Diagnostics at peripheral facilities

Yes

Yes*

No

Yes**

Yes**

No

Diagnostics at hospitals

Yes

Yes

Yes

Yes

Yes

Yes

Quality of care

Diagnostic test adherence (% test-negative patients prescribed malaria treatment)

Perceived good

Poor [30%;48%] [12,39]

Poor [20%] [20]

Poor [38%] [9]

Perceived poor

Perceived poor

Care-seeking behaviour

Extensive use of informal private sector

No

Yes [62]

No

Yes

No

No

Malaria epidemiology

Malaria endemicity in 2010 [37]

Malaria-free to moderate-risk

Malaria-free to high-risk

Moderate to high-risk

Moderate to high-risk

Moderate to high-risk

Malaria-free to high-risk