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 3 Dose–response negative binomial generalized linear mixed-effects models describing association between categories of malaria service point density 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
Population per malaria service point
> 2000	Ref.	–	–	Ref.	–	–	Ref.	–	–	Ref.	–	–
2000–1000	1.04	0.90, 1.20	0.636	1.00	0.87, 1.14	0.954	1.08	0.79, 1.48	0.635	1.18	0.91, 1.52	0.203
1000–750	0.98	0.80, 1.21	0.875	0.98	0.81, 1.19	0.865	1.14	0.74, 1.76	0.552	1.00	0.70, 1.43	0.985
< 750	0.72	0.60, 0.85	< 0.001	0.74	0.63, 0.87	< 0.001	0.64	0.44, 0.95	0.025	0.79	0.58, 1.08	0.146
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	0.70	0.58, 0.84	< 0.001	0.74	0.63, 0.86	< 0.001
% population protected by IRS	0.87	0.78, 0.97	0.012	0.84	0.76, 0.93	0.001	0.91	0.73, 1.15	0.432	0.95	0.79, 1.15	0.620
Rainfall anomaly^a	1.03	1.00, 1.05	0.023	1.03	1.01, 1.06	0.003	0.97	0.92, 1.01	0.169	0.98	0.94, 1.02	0.365
Number of health facilities with inpatient services	1.00	0.99, 1.00	0.234	0.99	0.98, 1.00	0.038	0.99	0.98, 1.00	0.073	0.99	0.98, 1.01	0.285
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	0.056	0.82	0.69, 0.97	0.019
March	0.99	0.90, 1.09	0.840	0.98	0.89, 1.08	0.680	0.98	0.80, 1.19	0.809	0.94	0.80, 1.11	0.464
April	1.05	0.95, 1.16	0.342	1.01	0.92, 1.11	0.838	0.86	0.71, 1.06	0.154	0.92	0.78, 1.09	0.349
May	0.96	0.86, 1.06	0.377	0.93	0.84, 1.02	0.119	0.89	0.73, 1.08	0.230	0.91	0.77, 1.07	0.247
June	0.65	0.58, 0.73	< 0.001	0.59	0.53, 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	0.39, 0.63	< 0.001	0.54	0.44, 0.66	< 0.001
August	0.46	0.41, 0.52	< 0.001	0.40	0.35, 0.44	< 0.001	0.47	0.37, 0.61	< 0.001	0.49	0.40, 0.60	< 0.001
September	0.52	0.46, 0.59	< 0.001	0.46	0.41, 0.51	< 0.001	0.48	0.37, 0.62	< 0.001	0.51	0.41, 0.62	< 0.001
October	0.61	0.54, 0.68	< 0.001	0.56	0.51, 0.63	< 0.001	0.57	0.45, 0.72	< 0.001	0.56	0.47, 0.68	< 0.001
November	0.65	0.58, 0.72	< 0.001	0.62	0.56, 0.69	< 0.001	0.55	0.44, 0.70	< 0.001	0.55	0.45, 0.66	< 0.001
December	0.83	0.74, 0.92	0.001	0.79	0.71, 0.88	< 0.001	0.74	0.59, 0.92	0.007	0.72	0.59, 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	0.80, 0.94	< 0.001	0.66	0.56, 0.79	< 0.001	0.69	0.60, 0.79	< 0.001
2018	0.79	0.72, 0.86	< 0.001	0.85	0.78, 0.92	< 0.001	0.66	0.55, 0.79	< 0.001	0.71	0.62, 0.83	< 0.001
2019	0.77	0.70, 0.84	< 0.001	0.79	0.72, 0.86	< 0.001	0.67	0.55, 0.81	< 0.001	0.72	0.62, 0.85	< 0.001
2020	0.91	0.80, 1.04	0.154	0.98	0.87, 1.11	0.767	0.94	0.72, 1.21	0.612	0.91	0.73, 1.13	0.375
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	1.23	0.53, 2.89	0.628
Luapula	4.87	2.08, 11.4	< 0.001	3.93	1.69, 9.15	0.002	6.30	2.64, 15.1	< 0.001	3.28	1.39, 7.73	0.007
Muchinga	3.09	1.24, 7.68	0.015	2.51	1.02, 6.22	0.046	2.30	0.90, 5.88	0.082	1.31	0.52, 3.30	0.572
Northern	2.54	1.09, 5.94	0.031	2.11	0.91, 4.91	0.084	2.49	1.04, 5.95	0.041	1.51	0.64, 3.57	0.345
North Western	4.16	1.75, 9.92	0.001	3.76	1.58, 8.92	0.003	3.17	1.30, 7.76	0.011	2.29	0.95, 5.52	0.065
Western	1.05	0.47, 2.35	0.901	1.17	0.53, 2.60	0.696	1.81	0.78, 4.17	0.164	1.33	0.59, 3.02	0.489

^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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