Table 4.
Malaria, pneumonia, and diarrhea case management results, by time point and study arm
| Baseline | Endline | Effect size (difference in differences) | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Arm 1 | Arm 2 | Control | Arm 1 | Arm 2 | Control | Arm 1, % change (95% CI) | P-value | Arm 2, % change (95% CI) | P-value | |
| Primary outcome: Correct case management of suspect uncomplicated malaria | ||||||||||
| Overall correct malaria case management* | 237/573 (43.7%) | 186/565 (30.2%) | 225/559 (42.8%) | 288/518 (55.8%) | 247/462 (50.9%) | 285/540 (59.6%) | −4.7 (−18.2, 8.9) | 0.501 | 3.9 (−14.1, 22.0) | 0.670 |
| Secondary outcomes: Malaria | ||||||||||
| 1. RDT/Blood smear performed | 327/428 (81.4%) | 339/440 (73%) | 384/490 (79.6%) | 365/463 (75.9%) | 324/411 (76.6%) | 410/522 (78.1%) | −4.0 (−14.0, 6.0) | 0.435 | 5.2 (−15.5, 25.8) | 0.623 |
| 2. First-line AM† | 212/281 (76.0%) | 227/283 (82.0%) | 238/272 (88.5%) | 156/181 (87.6%) | 131/147 (89.6%) | 177/190 (94.0%) | 6.1 (−16.2, 28.5) | 0.590 | 2.2 (−15.9, 20.3) | 0.812 |
| 3. If AL, correct dose | 175/221 (79.6%) | 240/257 (94.2%) | 210/265 (82.3%) | 109/113 (97.2%) | 108/111 (98.9%) | 136/139 (98.3%) | −1.7 (−19.5, 22.9) | 0.862 | −11.3 (−28.0, 5.4) | 0.186 |
| 4. If AL, tablets dispensed | 182/188 (97.1%) | 246/257 (95.7%) | 214/222 (97.2%) | 113/114 (99.1%) | 109/125 (87.2%) | 135/136 (99.8%) | −0.6 (−6.0, 4.8) | 0.831 | −10.5 (−27.2, 5.0) | 0.178 |
| 5. First dose AL given | 23/182 (11.9%) | 19/245 (5.4%) | 39/213 (27.8%) | 13/113 (13.7%) | 25/109 (20.1%) | 15/135 (12.2%) | 17.2 (−14.8, 49.1) | 0.292 | 30.4 (−5.7, 65.7) | 0.099 |
| 6. If AL, patient knows dose | 134/182 (74.3%) | 171/246 (68.3%) | 173/214 (86%) | 84/113 (71.7%) | 85/109 (78.2%) | 99/135 (77.7%) | 5.7 (−10.2, 21.7) | 0.482 | 18.2 (4.0, 32.4) | 0.012 |
| 7. If AL, patient told to complete | 108/182 (60.8%) | 135/247 (54%) | 119/214 (60.1%) | 50/113 (41.1%) | 62/109 (54.7%) | 71/135 (53.7%) | −13.3 (−38.0, 11.4) | 0.292 | 7.2 (−14.5, 29.0) | 0.515 |
| 8. IF RDT neg, no AM | 185/191 (97.2%) | 168/181 (94.8%) | 168/181 (95.9%) | 238/239 (99.7%) | 226/228 (99.5%) | 232/238 (98.3%) | 0.0 (−5.1, 5.0) | 0.992 | 2.3 (−4.6, 9.1) | 0.517 |
| 9. Correct treatment severe malaria | 0/33 (0%) | 3/25 (7.3%) | 0/32 (0%) | 3/16 (11.6%) | 0/10 (0%) | 0/6 (0%) | 11.6 | – | −7.3 | – |
| Secondary outcomes: Pneumonia and diarrhea | ||||||||||
| 1. Health worker measured respiratory rate if child had cough/difficult breathing | 5/115 (3.1%) | 4/137 (2.3%) | 0/120 (0%) | 5/185 (3.9%) | 0/118 (0%) | 5/161 (1.9%) | −1.1 | – | −4.2 | – |
| 2. Prescription of first-line antibiotic for children with pneumonia‡ | 31/45 (63.4%) | 39/56 (68.3%) | 29/42 (59%) | 57/80 (73.5%) | 39/51 (78.1%) | 48/68 (73%) | −3.8 (−38.4, 30.7) | 0.828 | −4.1 (−42.0, 33.8) | 0.831 |
| 3. First dose of antibiotic given at facility | 1/31 (2.2%) | 0/39 (0%) | 1/29 (4.4%) | 0/57 (0%) | 1/39 (3.1%) | 1/48 (0.7%) | 1.5 | – | 6.8 | – |
| 4. Prescription of oral rehydration solution to children with diarrhea§ | 57/93 (58.7%) | 73/98 (76.8%) | 48/81 (58.6%) | 35/64 (52.3%) | 22/39 (59.7%) | 39/69 (55.7%) | −3.5 (−24.7, 17.6) | 0.743 | −14.2 (−39.5, 11.1) | 0.272 |
AL = artemether–lumefantrine; CI = confidence interval; RDT = rapid diagnostic test; AM = antimalarial. Data are n/N (%) unless otherwise stated. Artemether–lumefantrine-related indicators for patients with suspected malaria. Suspect uncomplicated malaria: 72% at baseline and 60% at endline. Test positivity rate (facility malaria test): 47.5% at baseline and 35.1% at endline. Ninety percent patients attended facilities with AL in stock at baseline, 84% at endline.
* All applicable case management actions performed for patient with suspected uncomplicated malaria (Table 2).
† Among patients testing positive at facility for malaria or suspect malaria cases not tested at facilities unable to test.
‡ Among children with clinically diagnosed pneumonia, according to re-examination during exit interviews.
§ An alternative definition for correct diarrhea treatment including both ORS and zinc was used, but was lower overall: 38.2% and 35.0% at endline, with no significant differences by arm. This indicator was not used for diarrhea case management as zinc stocks were not systematically measured during the survey.