Table 4.
Descriptive typology of plausible explanations for quantitative results in six countries
| Rwanda | Uganda | Malawi | Benin | Mozambique | Burundi | ||
|---|---|---|---|---|---|---|---|
| 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 |
Information summarizes case study discussions and references [41-44] unless otherwise noted. Reported percentages of test-negative patients prescribed malaria treatment refers to all patients and is plausibly higher for young children and in routine program conditions. Benin and Malawi results based on national-level facility surveys.
*In Uganda, microscopy is available at HC-III and higher-level facilities.
**RDT stock-outs will reduce availability of diagnostics at peripheral clinics.