Table 1 Malaria messages sent to intervention Arm 1

Mon a.m.

“Check ALL patients with fever or history of fever for signs of severe malaria! If any severe sign TREAT & REFER urgently!” Better be safe than sorry

Mon p.m.

“Ask ALL patients about fever, take temperature and check other malaria signs and symptoms.” Where there is smoke there is fire

Tues a.m.

“Test for malaria ALL children < 5 and preg women with fever. Also test ALL patients ≥ 5 with fever + 1 symptom.” Look before you leap

Tues p.m.

“For febrile patients without severe signs TREAT for malaria ONLY if test is positive—do NOT treat negatives for malaria!” A word to the wise is sufficient

Wed a.m.

“When malaria test is NEGATIVE check for other causes; if none found give antipyretic and ask patient to return if fever persists!” Persistent work triumphs

Wed p.m.

“For uncomplicated malaria 1st line Rx is LA; 2nd line is ASAQ. For children < 5 kg and in 1st preg trimester give quinine + clindamycin.” Do the right thing

Thurs a.m.

“New pre-referral Rx for severe malaria is IM artesunate; if not available use IM quinine; if quinine O/S use rectal artesunate.” Never too old to learn

Thurs p.m.

“Prescribe LA based on WEIGHT: 1 × 6 for 5–14 kg; 2 × 6 for 15–24 kg; 3 × 6 for 25–34 kg; 4 × 6 for ≥ 35 kg.” A goal without a plan is just a wish

Fri a.m.

“Give FIRST LA DOSE to ALL patients with uncomplicated malaria at FACILITY even if on an empty stomach!” To be willing is to be able

Fri p.m.

“Advise ALL patients to take 2nd LA dose after 8 h, then every 12 h to complete all 6 doses even if they feel better!” Say little but say it well