Background
Methods
Study areas
Study design
Data collection
Data analysis
Ethics
Results
Public | Private | Total | ||||
---|---|---|---|---|---|---|
Characteristic | n | % | n | % | n | % |
State
| ||||||
Assam | 75 | 24.6 | 33 | 16.0 | 108 | 21.1 |
Goa | 46 | 15.1 | 20 | 9.7 | 66 | 12.9 |
Gujarat | 47 | 15.4 | 45 | 21.8 | 92 | 18.0 |
Delhi | 44 | 14.4 | 28 | 13.6 | 72 | 14.1 |
Jharkhand | 55 | 18.0 | 50 | 24.3 | 105 | 20.6 |
Orissa | 38 | 12.5 | 30 | 14.6 | 68 | 13.3 |
Facility type
| ||||||
District hospital/nursing home | 176 | 58.1 | 124 | 60.5 | 300 | 58.8 |
PHC, subcentre/clinic | 101 | 33.3 | 46 | 22.4 | 147 | 28.8 |
Other | 28 | 9.2 | 35 | 17.1 | 63 | 12.4 |
Experience (years)
| ||||||
< 2 | 39 | 12.9 | 11 | 5.4 | 50 | 9.8 |
2-10 | 94 | 31.0 | 56 | 27.3 | 150 | 29.5 |
10-20 | 94 | 31.0 | 66 | 32.2 | 160 | 31.5 |
> 20 | 76 | 25.1 | 72 | 35.1 | 148 | 29.1 |
Education
| ||||||
MBBS | 131 | 43.0 | 74 | 35.9 | 205 | 40.1 |
Post-graduate | 149 | 48.9 | 81 | 39.3 | 230 | 45.0 |
Non-allopathic | 25 | 8.2 | 51 | 24.8 | 76 | 14.9 |
Case management practices by physicians for uncomplicated malaria
Public | Private | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Treatment | Always | Often | Some | Rarely | Never | Always | Often | Some | Rarely | Never |
Chloroquine | 63.6 | 18.0 | 6.6 | 4.3 | 7.2 | 57.3 | 7.3 | 14.1 | 3.9 | 17.5 |
SP | 1.6 | 5.6 | 13.4 | 10.8 | 68.2 | 2.9 | 10.7 | 6.8 | 11.2 | 68.5 |
Mefloquine | 1.0 | 1.6 | 7.2 | 9.2 | 80.7 | 1.5 | 1.5 | 6.8 | 5.8 | 84.5 |
Quinine | 7.2 | 22.6 | 23.3 | 11.8 | 34.8 | 10.7 | 16.5 | 15.5 | 17.5 | 39.8 |
ASP | 14.1 | 11.2 | 20.0 | 8.5 | 45.9 | 10.2 | 12.1 | 10.2 | 5.8 | 61.7 |
As alone | 6.9 | 20.0 | 23.3 | 12.5 | 37.1 | 18.5 | 20.9 | 16.0 | 12.1 | 32.5 |
As+other | 3.6 | 4.9 | 10.8 | 7.2 | 73.1 | 7.8 | 3.9 | 4.9 | 4.9 | 78.6 |
Assam | Goa | |||||||||
Chloroquine | 65.7 | 14.8 | 9.3 | 2.8 | 7.4 | 87.9 | 6.1 | 1.5 | 0.0 | 3.0 |
SP | 0.9 | 6.5 | 15.7 | 18.5 | 58.3 | 3.0 | 1.5 | 4.6 | 9.1 | 80.3 |
Mefloquine | 0.0 | 0.0 | 3.7 | 7.4 | 88.9 | 4.6 | 3.0 | 6.1 | 12.1 | 72.7 |
Quinine | 10.2 | 29.6 | 29.6 | 17.6 | 13.0 | 6.1 | 1.5 | 16.7 | 22.7 | 51.5 |
ASP | 4.6 | 12.0 | 21.3 | 8.3 | 53.7 | 47.0 | 12.1 | 12.1 | 9.1 | 18.2 |
As alone | 6.5 | 18.5 | 27.8 | 11.1 | 36.1 | 9.1 | 4.6 | 4.6 | 3.0 | 77.3 |
As+other | 4.6 | 0.9 | 1.9 | 0.9 | 90.7 | 13.6 | 0.0 | 1.5 | 3.0 | 78.8 |
Gujarat | Delhi | |||||||||
Chloroquine | 79.4 | 2.2 | 1.1 | 1.1 | 16.3 | 55.6 | 34.7 | 1.4 | 0.0 | 8.3 |
SP | 1.1 | 5.4 | 6.5 | 1.1 | 85.9 | 2.8 | 15.3 | 18.1 | 12.5 | 51.4 |
Mefloquine | 0.0 | 1.1 | 1.1 | 1.1 | 96.7 | 2.8 | 2.8 | 23.6 | 8.3 | 62.5 |
Quinine | 5.4 | 10.9 | 10.9 | 8.7 | 64.1 | 2.8 | 16.7 | 18.1 | 9.7 | 52.8 |
ASP | 1.1 | 2.2 | 5.4 | 1.1 | 90.2 | 1.4 | 5.6 | 20.8 | 11.1 | 61.1 |
As alone | 13.0 | 15.2 | 22.8 | 15.2 | 33.7 | 8.3 | 19.4 | 11.1 | 18.1 | 43.1 |
As+other | 14.1 | 2.2 | 1.1 | 1.1 | 81.5 | 1.4 | 4.2 | 1.4 | 2.8 | 90.3 |
Jharkhand | Orissa | |||||||||
Chloroquine | 47.6 | 10.5 | 15.2 | 9.5 | 17.1 | 29.4 | 17.7 | 29.4 | 10.3 | 13.2 |
SP | 3.8 | 12.4 | 8.6 | 11.4 | 63.8 | 1.5 | 2.9 | 10.3 | 11.8 | 73.5 |
Mefloquine | 1.0 | 1.0 | 8.6 | 12.4 | 77.1 | 0.0 | 2.9 | 1.5 | 5.9 | 89.7 |
Quinine | 13.3 | 31.4 | 16.2 | 9.5 | 29.5 | 11.8 | 22.1 | 29.4 | 19.1 | 17.7 |
ASP | 6.7 | 14.3 | 14.3 | 10.5 | 54.3 | 27.9 | 25.0 | 23.5 | 4.4 | 19.1 |
As alone | 15.2 | 30.5 | 28.6 | 15.2 | 10.5 | 17.7 | 30.9 | 17.7 | 8.8 | 25.0 |
As+other | 1.9 | 1.0 | 1.9 | 3.8 | 91.4 | 7.4 | 0.0 | 0.0 | 0.0 | 92.7 |
Anti-malarial treatments prescribed to patients
Drug group/treatment | n | % | PQ | Abx |
---|---|---|---|---|
Artemisinin monotherapy | 271 | 14.8 | 6 | 75 |
Non-artemisinin monotherapy | 1, 241 | 68.0 | 520 | 98 |
Chloroquine | 1155 | 520 | 74 | |
Primaquine | 5 | |||
Quinine | 74 | 24 | ||
SP | 7 | |||
WHO ACT | 89 | 4.9 | 37 | 2 |
ASP blister | 30 | 2 | ||
ASP loose | 16 | 5 | ||
ASP+CQ | 37 | 31 | ||
ASP+Q | 3 | 1 | ||
ASP+CQ+Q | 3 | |||
Non-WHO ACT | 102 | 5.6 | 8 | 35 |
As+CQ | 63 | 7 | 19 | |
As+Q | 37 | 15 | ||
As+CQ+Q | 2 | 1 | 1 | |
Non-artemisinin combination | 15 | 0.8 | 7 | 0 |
CQ+SP | 13 | 7 | ||
CQ+Q | 2 | |||
No anti-malarial drug | 108 | 5.9 | 0 | 23 |
Missing | 6 | |||
1832 | 583 | 233 |
Patient experiences of physician case management
Unadjusted | Adjusted | ||||||
---|---|---|---|---|---|---|---|
AM | Other | % | OR | 95%CI | OR | 95%CI | |
State
| |||||||
Assam | 9 | 296 | 3.0 | -- | -- | ||
Goa | 1 | 217 | 0.5 | 0.2 | 0.0, 1.2 | 0.0 | 0.0, 0.4 |
Gujarat | 24 | 197 | 10.9 | 4.0 | 1.8, 8.9 | 0.9 | 0.3, 2.8 |
Delhi | 24 | 293 | 7.6 | 2.7 | 1.2, 5.9 | 5.4 | 1.7, 18 |
Jharkhand | 185 | 266 | 41.0 | 23 | 11, 49 | 5.5 | 2.1, 15 |
Orissa | 30 | 285 | 9.5 | 3.5 | 1.6, 7.5 | 0.3 | 0.1, 1.1 |
Facility type
| |||||||
Hospital | 240 | 1, 139 | 17.4 | -- | -- | ||
Primary clinic | 33 | 415 | 7.4 | 0.4 | 0.3, 0.6 | 0.6 | 0.3, 1.1 |
Age
| |||||||
< 15 yrs | 63 | 444 | 12.4 | -- | -- | ||
≥15 yrs | 209 | 1105 | 15.9 | 1.3 | 1.0, 1.8 | 1.8 | 1.2, 2.9 |
Sex
| |||||||
Male | 150 | 957 | 13.6 | -- | -- | ||
Female | 123 | 597 | 17.1 | 1.3 | 1.0, 1.7 | 0.8 | 0.6, 1.3 |
Sector
| |||||||
Government | 241 | 1357 | 15.1 | -- | -- | ||
Private | 32 | 197 | 14.0 | 0.9 | 0.6, 1.4 | 8.0 | 3.8, 17 |
Diagnosis
| |||||||
Blood Slide | 97 | 1, 122 | 8.0 | -- | -- | ||
RDK | 119 | 190 | 38.5 | 7.2 | 5.2, 10 | 1.5 | 0.9, 2.7 |
Both | 22 | 100 | 18.0 | 2.5 | 1.5, 4.2 | 1.8 | 0.9, 3.7 |
None | 35 | 129 | 21.3 | 2.9 | 1.9, 4.4 | ||
Result
| |||||||
Malaria positive | 194 | 621 | 23.8 | -- | |||
Malaria negative | 36 | 503 | 6.7 | 0.2 | 0.2, 0.3 | ||
Unknown | 8 | 298 | 2.6 | 0.1 | 0.0, 0.2 | ||
Species
| |||||||
P. vivax
| 18 | 306 | 5.6 | -- | -- | ||
P. falciparum
| 166 | 305 | 35.2 | 9.3 | 5.4, 16 | 4.2 | 2.2, 7.8 |
Mixed infection | 4 | 6 | 40.0 | 11 | 2.8, 46 | 5.0 | 0.9, 28 |