Health worker adherence to malaria treatment guidelines at outpatient health facilities in southern Malawi following implementation of universal access to diagnostic testing

Table 6 Factors associated with appropriate testing among suspect uncomplicated malaria patients (N = 1427)

Factors	Number of patients	Number tested (weighted %)	Unadjusted OR (95% CI)	p value	Adjusted OR (95% CI)	p value
Patient spontaneously reported these complaints to the HW
Fever
Yes	950	784 (81.8)	2.6 (1.6–4.3)	<0.0001	2.6 (1.7–4.0)	<0.0001
No	477	288 (62.9)	Ref		Ref
Headache
Yes	481	380 (79.4)	1.4 (0.9–1.9)	0.055	1.5 (1.1–2.2)	0.017
No	946	692 (73.8)	Ref		Ref
Vomiting
Yes	223	194 (86.1)	2.2 (1.2–4.2)	0.016	2.0 (1.0–4.0)	0.040
No	1204	878 (73.8)	Ref		Ref
Skin problem
Yes	80	37 (49.0)	0.3 (0.2–0.5)	<0.0001	0.4 (0.2–0.6)	0.0001
No	1347	1035 (77.1)	Ref		Ref

	n/N	Weighted percent (95% CI)	OR (95% CI)	p value
Interaction term included in the model: supervision * 2013 malaria treatment guidelines available
Supervision * Guidelines	299/389	75.9 (66.1, 85.8)	2.2 (0.8, 6.6)	0.143
Supervision * No guidelines	438/559	78.8 (69.5, 88.0)	2.7 (0.9, 8.0)	0.073
No supervision * Guidelines	161/190	87.4 (77.6, 97.2)	6.2 (1.6, 24.7)	0.009
No supervision * No guidelines	174/289	56.8 (36.2, 77.4)	Ref

Ref means referent group
Interaction term included in the model. Other factors with p value ≥0.1 in the univariate analysis that were not included in the multivariable model were: (1) Patient-level factors: patient spontaneous report to the HW of malaria, chills, fatigue, joint pain, weakness or cough; (2) HW-level factors: HW age, number of patients seen by the HW, number of years of formal training received, number of years of clinical experience, latest training on malaria case management, access to the latest malaria treatment guidelines and supervision in the last 6 months; (3) HF-level factors: MoH vs CHAM operated HFs, availability of thermometers, number of patients at the HF and the number of HWs at the HF

ISSN: 1475-2875