Table 4.
Association of endemicity and age with non-prescription of ACT among mRDT-positive patients
| Project site | mRDT positivity | Age (years) | Number (%) of mRDT-positive patients not prescribed ACT by proxy endemicity setting* | Unadjusted | Adjusted† | ||||
|---|---|---|---|---|---|---|---|---|---|
| OR | 95% CI‡ | p value‡ | OR | 95% CI‡ | p value‡ | ||||
| (i) Effect of endemicity setting on ACT non-prescription in baseline age group (< 5 years) | |||||||||
| Nige1 | High | < 5 | 95/399 (23.8) | 1.00 | Ref. | 0.004 | 1.00 | Ref. | 0.077 |
| Mod–high | 62/134 (46.3) | 2.76 | 1.39, 5.45 | 1.98 | 0.93, 4.22 | ||||
| Tanz1 | Mod–high | < 5 | 47/173 (27.2) | 1.00 | Ref. | 0.026 | 1.00 | Ref. | 0.027 |
| Low | 41/64 (64.1) | 4.78 | 1.21, 18.93 | 4.80 | 1.19, 19.34 | ||||
| Tanz2 | Mod–low | < 5 | 770/4102 (18.8) | 1.00 | Ref. | 0.001 | 1.00 | Ref. | < 0.001 |
| Low | 177/294 (60.2) | 6.55 | 2.88, 14.85 | 6.22 | 2.70, 14.35 | ||||
| Uga2§ | Mod–high | < 1 | 46/3364 (1.4) | 1.00 | Ref. | < 0.001 | 1.00 | Ref. | < 0.001 |
| Low | 11/35 (31.4) | 33.1 | 11.88, 92.00 | 32.49 | 11.36, 92.92 | ||||
| (ii) Effect of age on ACT non-prescription in differing areas of endemicity | |||||||||
| Nige1 | High | < 5 | 10/26 (38.5) | 1.00 | Ref. | 0.052 | 1.00 | Ref. | 0.051 |
| ≥ 5 | 85/373 (22.8) | 0.47 | 0.22, 1.01 | 0.47 | 0.22, 1.00 | ||||
| Mod–high‖ | < 5 | 6/16 (37.5) | – | – | – | – | – | – | |
| ≥ 5 | 56/118 (47.5) | ||||||||
| Tanz1 | Mod–high | < 5 | 34/110 (30.9) | 1.00 | Ref. | 0.226 | 1.00 | Ref. | 0.221 |
| ≥ 5 | 13/63 (20.6) | 0.58 | 0.24, 1.40 | 0.58 | 0.24, 1.39 | ||||
| Low | < 5 | 30/43 (69.8) | 1.00 | Ref. | 0.132 | 1.00 | Ref. | 0.124 | |
| ≥ 5 | 11/21 (52.4) | 0.48 | 0.18, 1.25 | 0.47 | 0.18, 1.23 | ||||
| Tanz2 | Mod–high | < 5 | 212/1429 (14.8) | 1.00 | Ref. | < 0.001 | 1.00 | Ref. | < 0.001 |
| ≥ 5 | 558/2673 (20.9) | 1.51 | 1.23, 1.86 | 1.51 | 1.23, 1.86 | ||||
| Low | < 5 | 35/51 (68.6) | 1.00 | Ref. | 0.117 | 1.00 | Ref. | 0.109 | |
| ≥ 5 | 142/243 (58.4) | 0.64 | 0.37, 1.12 | 0.67 | 0.43, 1.09 | ||||
| Uga2§ | Mod–high | < 1 | 10/238 (4.2) | 1.00 | Ref. | 0.012 | 1.00 | Ref. | 0.013 |
| ≥ 1 | 36/3104 (1.2) | 0.27 | 0.10, 0.75 | 0.27 | 0.09, 0.75 | ||||
| Low‖ | < 1 | 1/4 (25.0) | – | – | – | – | – | – | |
| ≥ 1 | 10/31 (32.3) | ||||||||
*n is number of patients per study site not prescribed ACT among all mRDT-positive patients with complete data for age, gender, endemicity setting, sector, and intervention arm. Total number of mRDT-positive patients not prescribed ACT: N = 7291/104,454
†All adjusted models included age and gender as a priori variables and where sufficient data available (≥ 10 outcomes per cell), plus all other variables found significant by univariate analyses (p < 0.05). Statistical models for each site vary in composition due to differences in study designs. Final regression models for each site include the following variables: Nige1—gender, age, sector, and endemicity; Tanz1—gender, age, and endemicity setting; Tanz2—gender, age, and endemicity setting; Uga2—gender, age, and endemicity setting; Nige1 (high)—gender and age; Tanz1 (mod–high)—gender and age; Tanz1 (low)—gender and age; Tanz2 (mod–high)—gender and age; Tanz2 (low)—gender, age, and intervention arm; and Uga2 (mod–high)—gender and age. Nige1 (mod–high) and Uga2 (low) had insufficient outcomes in binary age categories to undergo analysis
‡Confidence intervals and p value calculated using Wald’s test
§Uga2 age categories </≥ 1 due to primary study limited to patients aged under 6 years
‖Analysis not undertaken due to insufficient number of outcomes