Table 2.
Time trends in health workers’ compliance with the outpatient malaria guidelines by epidemiological zones, 2010–2016
| Lake endemic | Coast endemic | Highland epidemic | Semi-arid, seasonal transmission | Low risk | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| N (Mean† %) | Time trend* [95% CI] (p-value) | N (Mean %) | Time trend [95% CI] (p-value) | N (Mean %) | Time trend [95% CI] (p-value) | N (Mean %) | Time trend [95% CI] (p-value) | N (Mean %) | Time trend [95% CI] (p-value) | |
| Primary indicators—‘test and treat’ compliance | ||||||||||
| Malaria testing of febrile patients | 2766 (74.5) | 1.71 [1.51–1.93] (< 0.001) | 932 (54.6) | 1.13 [0.95–1.35] (0.165) | 1898 (58.5) | 1.32 [1.18–1.49] (< 0.001) | 2071 (51.2) | 0.93 [0.83–1.04] (0.212) | 1506 (41.0) | 0.89 [0.79–1.01] (0.064) |
| AL treatment for test positive patients | 1178 (88.4) | 1.56 [1.26–1.92] (< 0.001) | 189 (87.8) | 1.77 [1.07–2.94] (0.026) | 304 (86.2) | 1.18 [0.85–1.66] (0.326) | 400 (88.8) | 1.01 [0.72–1.40] (0.973) | 129 (87.6) | 0.70 [0.44–1.12] (0.134) |
| Compliance with test negative results | 882 (71.5) | 2.04 [1.65–2.54] (< 0.001) | 321 (90.7) | 3.12 [1.76–5.53] (< 0.001) | 806 (74.8) | 1.80 [1.45–2.24] (< 0.001) | 661 (83.2) | 1.34 [1.06–1.69] (0.013) | 490 (88.0) | 2.27 [1.61–3.19] (< 0.001) |
| Composite “test and treat” compliance | 2766 (60.5) | 1.80 [1.61–2.01] (< 0.001) | 932 (48.9) | 1.24 [1.05–1.46] (0.010) | 1898 (45.6) | 1.47 [1.32–1.65] (< 0.001) | 2071 (43.7) | 0.98 [0.88–1.09] (0.726) | 1506 (36.1) | 0.97 [0.87–1.09] (0.651) |
| Secondary indicators—AL dosing, dispensing, and counselling compliance | ||||||||||
| Correct prescribing of AL dose | 1561 (93.5) | 0.95 [0.85–1.08] (0.446) | 251 (92.4) | 0.94 [0.74–1.20] (0.617) | 637 (91.8) | 0.89 [0.76–1.06] (0.192) | 687 (90.5) | 1.17 [0.97–1.41] (0.107) | 187 (90.4) | 0.98 [0.73–1.31] (0.880) |
| Weighing of patients prescribed AL | 1570 (72.5) | 1.17 [1.01–1.36] (0.044) | 269 (55.0) | 1.11 [0.83–1.49] (0.468) | 635 (44.7) | 1.02 [0.84–1.23] (0.874) | 686 (33.8) | 1.15 [0.93–1.42] (0.204) | 184 (35.9) | 0.99 [0.73–1.35] (0.960) |
| First AL dose administered at the facility | 1570 (44.6) | 2.33 [1.76–3.10] (< 0.001) | 269 (49.1) | 5.02 [2.77–9.09] (< 0.001) | 635 (30.9) | 1.25 [0.90–1.75] (0.191) | 686 (23.8) | 1.44 [1.02–2.04] (0.039) | 184 (29.4) | 1.47 [0.85–2.53] (0.168) |
| Explanation of AL dosage | 1569 (95.1) | 0.98 [0.84–1.14] (0.794) | 269 (97.8) | 1.04 [0.69–1.56] (0.869) | 635 (92.6) | 1.04 [0.85–1.28] (0.684) | 686 (92.6) | 1.13 [0.90–1.43] (0.297) | 184 (95.1) | 1.28 [0.79–2.05] (0.317) |
| Advised to take the second AL dose after 8 h | 1569 (74.0) | 1.27 [1.09–1.48] (0.003) | 269 (90.3) | 1.37 [0.93–2.02] (0.108) | 635 (71.2) | 1.05 [0.86–1.27] (0.656) | 686 (62.2) | 1.02 [0.83–1.27] (0.838) | 184 (73.9) | 1.07 [0.77–1.49] (0.673) |
| Advised to take drugs after meals | 1568 (61.2) | 1.04 [0.95–1.14] (0.364) | 269 (72.5) | 1.05 [0.87–1.26] (0.643) | 635 (55.4) | 0.92 [0.82–1.05] (0.209) | 686 (63.6) | 1.04 [0.90–1.20] (0.572) | 184 (69.6) | 1.00 [0.80–1.26] (0.975) |
| Advised what to do in case of vomiting | 1570 (6.1) | 1.10 [0.94–1.29] (0.225) | 269 (11.5) | 1.15 [0.87–1.53] (0.325) | 635 (6.3) | 1.03 [0.82–1.30] (0.800) | 686 (5.8) | 1.23 [0.96–1.59] (0.107) | 184 (3.8) | 1.13 [0.70–1.82] (0.612) |
| Advised to complete all AL doses | 1567 (83.0) | 1.06 [0.96–1.18] (0.258) | 269 (79.2) | 1.20 [0.97–1.49] (0.090) | 635 (80.8) | 0.91 [0.79–1.04] (0.165) | 686 (81.0) | 1.03 [0.88–1.20] (0.743) | 184 (83.7) | 0.92 [0.71–1.19] (0.521) |
†The mean indicator value across 11 survey rounds;
*Change in the odds of the indicator per year within each malaria risk zone; Bold font indicates a significant trend at p < 0.05