Effectiveness of community case management of malaria on severe malaria and inpatient malaria deaths in Zambia: a dose–response study using routine health information system data

Ashton, Ruth A.; Hamainza, Busiku; Lungu, Chris; Rutagwera, Marie-Reine I.; Porter, Travis; Bennett, Adam; Hainsworth, Michael; Burnett, Sarah; Silumbe, Kafula; Slater, Hannah; Eisele, Thomas P.; Miller, John M.

doi:10.1186/s12936-023-04525-2

Table 2 Dose–response negative binomial generalized linear mixed-effects models describing association between the number of malaria service points per 1000 population as a continuous variable and the four primary outcome indicators

From: Effectiveness of community case management of malaria on severe malaria and inpatient malaria deaths in Zambia: a dose–response study using routine health information system data

	Malaria admissions, children < 5 years			Malaria admissions, all ages			Inpatient malaria deaths, children < 5 years			Inpatient malaria deaths, all ages
	IRR	95% CI	p	IRR	95% CI	p	IRR	95% CI	p	IRR	95% CI	p
Malaria service points per 1000 population	0.81	0.75, 0.87	< 0.001	0.84	0.78, 0.90	< 0.001	0.77	0.66, 0.91	0.002	0.78	0.68, 0.89	< 0.001
One-month lag of outcome variable	1.01	1.01, 1.01	< 0.001	1.01	1.00, 1.01	< 0.001	1.10	1.07, 1.13	< 0.001	1.09	1.07, 1.11	< 0.001
Total ITNs distributed in previous 12 months	0.84	0.77, 0.92	< 0.001	0.84	0.77, 0.91	< 0.001	0.69	0.58, 0.83	< 0.001	0.74	0.63, 0.86	< 0.001
% population protected by IRS	0.87	0.78, 0.97	0.014	0.85	0.76, 0.94	0.001	0.91	0.73, 1.14	0.431	0.96	0.80, 1.15	0.650
Rainfall anomaly^a	1.03	1.00, 1.05	0.021	1.03	1.01, 1.06	0.003	0.97	0.92, 1.01	0.173	0.98	0.94, 1.02	0.356
Number of health facilities with inpatient services	1.00	0.99, 1.00	0.316	0.99	0.99, 1.00	0.060	0.99	0.98, 1.00	0.078	0.99	0.98, 1.01	0.333
Month (categorical)
January	Ref.	–	–	Ref.	–	–	Ref.	–	–	Ref.	–	–
February	0.86	0.77, 0.95	0.003	0.82	0.75, 0.91	< 0.001	0.82	0.67, 1.00	0.052	0.82	0.69, 0.97	0.019
March	0.99	0.90, 1.09	0.846	0.98	0.89, 1.08	0.693	0.97	0.80, 1.19	0.794	0.94	0.80, 1.11	0.461
April	1.05	0.95, 1.17	0.312	1.01	0.92, 1.11	0.795	0.87	0.71, 1.06	0.162	0.93	0.78, 1.09	0.360
May	0.96	0.86, 1.06	0.384	0.93	0.84, 1.02	0.119	0.89	0.73, 1.08	0.231	0.91	0.77, 1.07	0.255
June	0.65	0.58, 0.73	< 0.001	0.60	0.54, 0.66	< 0.001	0.62	0.49, 0.79	< 0.001	0.66	0.55, 0.80	< 0.001
July	0.49	0.44, 0.55	< 0.001	0.45	0.40, 0.50	< 0.001	0.49	0.38, 0.63	< 0.001	0.54	0.44, 0.66	< 0.001
August	0.46	0.41, 0.52	< 0.001	0.40	0.36, 0.44	< 0.001	0.47	0.36, 0.61	< 0.001	0.49	0.40, 0.61	< 0.001
September	0.52	0.47, 0.59	< 0.001	0.46	0.41, 0.51	< 0.001	0.48	0.37, 0.62	< 0.001	0.51	0.42, 0.63	< 0.001
October	0.61	0.55, 0.68	< 0.001	0.57	0.51, 0.63	< 0.001	0.57	0.45, 0.71	< 0.001	0.56	0.47, 0.68	< 0.001
November	0.65	0.59, 0.73	< 0.001	0.63	0.56, 0.69	< 0.001	0.56	0.44, 0.70	< 0.001	0.55	0.45, 0.66	< 0.001
December	0.83	0.75, 0.93	0.001	0.80	0.72, 0.88	< 0.001	0.74	0.59, 0.93	0.008	0.72	0.60, 0.86	< 0.001
Year (categorical)
2015	Ref.	–	–	Ref.	–	–	Ref.	–	–	Ref.	–	–
2016	0.84	0.78, 0.91	< 0.001	0.88	0.82, 0.95	0.001	0.72	0.61, 0.84	< 0.001	0.79	0.69, 0.90	< 0.001
2017	0.83	0.76, 0.90	< 0.001	0.87	0.81, 0.94	0.001	0.66	0.56, 0.79	< 0.001	0.69	0.60, 0.79	< 0.001
2018	0.79	0.73, 0.87	< 0.001	0.85	0.79, 0.92	< 0.001	0.66	0.56, 0.79	< 0.001	0.72	0.62, 0.83	< 0.001
2019	0.78	0.71, 0.86	< 0.001	0.80	0.74, 0.88	< 0.001	0.68	0.56, 0.82	< 0.001	0.73	0.62, 0.86	< 0.001
2020	0.94	0.82, 1.07	0.330	1.02	0.90, 1.15	0.803	0.96	0.74, 1.25	0.779	0.92	0.74, 1.14	0.431
Province
Copperbelt	Ref.	–	–	Ref.	–	–	Ref.	–	–	Ref.	–	–
Eastern	2.29	0.99, 5.29	0.052	1.80	0.78, 4.14	0.167	2.35	0.99, 5.59	0.053	1.24	0.53, 2.91	0.621
Luapula	4.85	2.08, 11.3	< 0.001	3.91	1.68, 9.11	0.002	6.30	2.63, 15.1	< 0.001	3.28	1.39, 7.75	0.007
Muchinga	3.07	1.24, 7.63	0.016	2.51	1.01, 6.21	0.047	2.28	0.89, 5.83	0.085	1.29	0.51, 3.27	0.586
Northern	2.53	1.08, 5.91	0.032	2.10	0.90, 4.89	0.086	2.48	1.03, 5.92	0.042	1.50	0.64, 3.55	0.353
North Western	4.23	1.78, 10.1	0.001	3.82	1.61, 9.05	0.002	3.25	1.33, 7396	0.010	2.33	0.97, 5.61	0.060
Western	1.07	0.48, 2.39	0.868	1.20	0.54, 2.67	0.655	1.83	0.80, 4.23	0.154	1.34	0.59, 3.04	0.477

^aRainfall anomalies are lagged and standardized. 3-month lags were used in inpatient deaths models, and 2-month lag in admissions models

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