Background
Methods
Search strategy
Inclusion criteria
Analysis of studies
Results
ACT stock
ACT prescribing at all facilities
Country, Year | % (No.) of patients diagnosed with uncomplicated malaria/fever and prescribed ACT | |||
---|---|---|---|---|
At all facilities, % (n) | At facilities with ACT stock, %(n) | At facilities with no ACT stock, %(n) | % differencea (95% Confidence Intervalc; p-value) | |
Kenya, 2006 [19] | 26.4% (248/940) | 28.1% (243/866) | 6.8% (5/74) |
21.3%
(14.1%, 28.5%; p < 0.001) |
Kenya, 2010 [14] |
< 5 yrs
|
< 5 yrs
|
< 5 yrs
|
< 5 yrs
|
62.3% (592/950) | 64.1% (585/913) | 18.9% (7/37) |
45.2%
(30.8%, 59.6%; p < 0.001) | |
≥ 5 yrs
|
≥ 5 yrs
|
≥ 5 yrs
|
≥ 5 yrs
| |
63.5% (746/1175) | 65.7% (730/1112) | 25.4% (16/63) |
40.3%
(28.3%, 52.2%; p < 0.001) | |
Uganda, 2007 [18] |
< 5 yrs
|
< 5 yrs
|
< 5 yrs
|
< 5 yrs
|
66.4% (306/461) | 69.4% (297/428) | 27.3% (9/33) |
42.1%
(24.7%, 59.7%; p < 0.001) | |
≥ 5 yrs
|
≥ 5 yrs
|
≥ 5 yrs
|
≥ 5 yrs
| |
56.2% (415/739) | 60.3% (388/644) | 28.4% (27/95) |
31.9%
(21.4%, 42.3%; p < 0.001) | |
Zambia, 2004 [16] |
≥ 10 kg
|
≥ 10 kg
|
≥ 10 kg
|
≥ 10 kg
|
10.7% (42/394) | 21.9% (42/192) | 0/202 |
21.9%
| |
Zambia, 2006 [17] |
5-9 kg
|
5-9 kg
|
5-9 kg
|
5-9 kg
|
27.0% (149/552) | 41.0% (144/351) | 2.5% (5/201) |
38.5%
(32.6%, 44.5%; p < 0.001) | |
≥ 10 kg
|
≥ 10 kg
|
≥ 10 kg
|
≥ 10 kg
| |
42.2% (231/547) | 58.6% (219/374) | 6.9% (12/173) |
51.7%
(44.9%, 58.3%; p < 0.001) | |
Zambia, 2006 [15]b | 33.9% (494/1457) | 44.7% (465/1040) | 7% (29/417) |
37.7%
(33.7%, 41.8%; p < 0.001) |
ACT prescribing in the presence and absence of stock
Alternative anti-malarial prescribing
Country, Year | % (No.) of patients diagnosed with uncomplicated malaria/fever and prescribed Alternative (non-ACT) Anti-Malarial | |||
---|---|---|---|---|
At all facilities, % (n) | At facilities with ACT stock, % (n) | At facilities with no ACT stock, % (n) | % differencea (95% Confidence Intervalc; p-value) | |
Kenya, 2006 [19] | 50.5% (475/940) | 47.8% (414/866) | 82.4% (61/74) |
-34.6%
(-44.6%, -24.6%; p < 0.001) |
Kenya, 2010 [14] | 8.6% (183/2125) | 8% (162/2025) | 21% (21/100) |
-13%
(-21.6%, -4.4%; p < 0.001) |
Uganda, 2007 [18] |
< 5 yrs
|
< 5 yrs
|
< 5 yrs
|
< 5 yrs
|
19.5% (90/461) | 16.4% (70/428) | 60.6% (20/33) |
-44.2%
(-62.9%, -25.6%; p < 0.001) | |
≥ 5 yrs
|
≥ 5 yrs
|
≥ 5 yrs
|
≥ 5 yrs
| |
26.7% (197/739) | 22.5% (145/644) | 54.7% (52/95) |
-32.2%
(-43.3%, -21.1%; p < 0.001) | |
Zambia, 2004 [16] |
≥ 10 kg
|
≥ 10 kg
|
≥ 10 kg
|
≥ 10 kg
|
72.3% (285/394) | 56.8% (109/192) | 87.1% (176/202) |
-30.3%
(-39.3%, -21.5%, p < 0.001) | |
Zambia, 2006 [17] |
5-9 kg
|
5-9 kg
|
5-9 kg
|
5-9 kg
|
43.5% (240/552) | 24.2% (85/351) | 77.1% (155/201) |
-52.9%
(-60.6%, -45.2%; p < 0.001) | |
≥ 10 kg
|
≥ 10 kg
|
≥ 10 kg
|
≥ 10 kg
| |
34.6% (189/547) | 17.4% (65/374) | 71.7% (124/173) |
-54.3%
(-62.5%, -46.1%; p < 0.001) | |
Zambia, 2006 [15]b | 36.6% (533/1457) | 23.1% (240/1040) | 70.3% (293/417) |
-47.2%
(-52.4%, -41.9%; p < 0.001) |
Country, year of study | Percentage of patients diagnosed with uncomplicated malaria/fever and prescribed alternative anti-malarials to ACT | |||
---|---|---|---|---|
All facilities, % (n) | Facilities with ACT stock, %(n) | No ACT stock | % differencea (95% Confidence Intervalb; p-value) | |
Kenya, 2006 [19] |
AQ
|
AQ
|
AQ
|
AQ
|
38.6% (363/940) | 36.7% (318/866) | 60.8% (45/74) |
-24.1%
(-36.4%, -11.8%; p < 0.001) | |
SP
|
SP
|
SP
|
SP
| |
4.4% (41/940) | 3.2% (28/866) | 17.6% (13/74) |
-14.4%
(-23.8%, 4.8%; p < 0.001) | |
AQ+SP
|
AQ+SP
|
AQ+SP
|
AQ+SP
| |
2.8% (26/940) | 3% (26/866) | 0/74 |
3%
| |
Other AM
c
|
Other AM
c
|
Other AM
c
|
Other AM
c
| |
3.3% (31/940) | 3.3% (29/866) | 2.7% (2/74) |
0.6%
(0.3%, 11%; p = 1.0) | |
QN
|
QN
|
QN
|
QN
| |
1.5% (14/940) | 1.5% (13/866) | 1.4% (1/74) |
0.1%
(0.16%, 46.6%; p = 1.0) | |
Kenya, 2010 [14]e |
AL+QN
|
AL+QN
|
AL+QN
|
AL+QN
|
<5 yrs: 5.8% (55/950) ≥ 5 yrs: 2.6% (31/1175) | <5 yrs: 6% (55/913) ≥ 5 yrs: 2.8% (31/1112) | <5 yrs: 0/37 ≥ 5 yrs: 0/63 | <5 yrs: 6% ≥ 5 yrs: 2.8% | |
SP
|
SP
|
SP
|
SP
| |
2.6% (56/2125) | 1.9% (38/2025) | 18% (18/100) | -16.1%(-24.2%, 8%; p < 0.001) | |
QN
|
QN
|
QN
|
QN
| |
<5 yrs: 2.6% (25/950) ≥ 5 yrs: 1.4% (16/1175) | <5 yrs: 2.6% (24/913) ≥ 5 yrs: 1.3% (14/1112) | <5 yrs: 2.7% (1/37) ≥ 5 yrs: 3.2% (2/63) | <5 yrs:-0.1% (-0.1%, 41.1%; p = 1.0) ≥ 5 yrs: -1.9% (-3.6%, .09%; p = 0.2) | |
Uganda, 2007 [18] |
CQ+SP
|
CQ+SP
|
CQ+SP
|
CQ+SP
|
<5 yrs: 7.6% (35/461) ≥ 5 yrs: 18% (133/739) | < 5 yrs: 5.1% (22/428) ≥ 5 yrs: 14.8% (95/644) | < 5 yrs: 39.4% (13/33) ≥ 5 yrs: 40.0% (38/95) |
< 5 yrs: -34.3%
(-81.4%, -45.8%; p < 0.001)
≥ 5 yrs: -25.2%
(-36.1%, -14.4%; p < 0.001) | |
CQ
|
CQ
|
CQ
|
CQ
| |
< 5 yrs: 2.2% (10/461) ≥ 5 yrs: 3% (22/739) | < 5 yrs: 2.1% (9/428) ≥ 5 yrs: 2.5% (16/644) | < 5 yrs: 3% (1/33) ≥ 5 yrs: 6.3% (6/95) |
< 5 yrs: -0.9%
(-31.1%, 0.1%; p = 0.5)
≥ 5 yrs: -3.8%
(-9.5%, 1.8%; p = 0.08) | |
SP
|
SP
|
SP
|
SP
| |
< 5 yrs: 0.4% (2/461) ≥ 5 yrs: 1.0% (7/739) | < 5 yrs: 0.5% (2/428) ≥ 5 yrs: 0.9% (6/644) | < 5 yrs: 0 (0/33) ≥ 5 yrs: 1.0% (1/95) |
< 5 yrs: 0.5%
≥ 5 yrs: -0.1%
(0.1%, 41.1%; p = 1)
| |
QN
|
QN
|
QN
|
QN
| |
< 5 yrs: 5.9% (27/461) ≥ 5 yrs: 2.8% (21/739) | < 5 yrs: 5.1% (22/428) ≥ 5 yrs: 2.5% (16/644) | < 5 yrs: 15.2% (5/33) ≥ 5 yrs: 5.3% (5/95) | < 5 yrs: -10.1% (-24.1%, 4%; p = 0.05) ≥ 5 yrs: -2.8% (-8%, 2.5%; p = 0.2) | |
Other AM
d
|
Other AM
d
|
Other AM
d
|
Other AM
d
| |
< 5 yrs: 3.5% (16/461) ≥ 5 yrs: 1.9% (14/739) | < 5 yrs: 3.5% (15/428) ≥ 5 yrs: 1.9% (12/644) | < 5 yrs: 3.0% (1/33) ≥ 5 yrs: 2.1% (2/95) |
< 5 yrs: 0.5%
(0.16%,48.9%; p = 1.0)
≥ 5 yrs: -0.2%
(0.19%, 8.2%; p = 0.7) | |
Zambia, 2004 [16] |
SP
|
SP
|
SP
|
SP
|
≥ 10 kg: 67.5% (266/394) | ≥ 10 kg: 53.7% (103/192) | ≥ 10 kg: 80.7% (163/202) |
≥ 10 kg: -27%
(-36.5%, -17.6%; p < 0.001) | |
QN
|
QN
|
QN
|
QN
| |
≥ 10 kg: 4.8% (19/394) | ≥ 10 kg: 3.1% (6/192) | ≥ 10 kg: 6.4% (13/202) |
≥ 10 kg: -3.3%
(-8%, 1.4%; p = 0.2) | |
Zambia, 2006 [17] |
SP
|
SP
|
SP
|
SP
|
5-9 kg: 38.8% (214/552) ≥ 10 kg: 27.6% (151/547) | 5-9 kg: 21.9% (77/351) ≥ 10 kg: 13.6% (51/374) | 5-9 kg: 68.2% (137/201) ≥ 10 kg: 57.8% (100/173) |
5-9 kg: -46.3%
(-54.4%, -38.1%; p < 0.001) ≥ 10 kg: -44.2% (-52.7%, -35.6%; p < 0.001) | |
QN
|
QN
|
QN
|
QN
| |
5-9 kg: 4.7% (26/552) ≥ 10 kg: 7.0% (38/547) | 5-9 kg: 2.3% (8/351) ≥ 10 kg: 3.7% (14/374) | 5-9 kg: 9.0% (18/201) ≥ 10 kg: 13.9% (24/173) | 5-9 kg:-6.7% (-11.3%, -2,%; p < 0.001) ≥ 10 kg:-10.2% (-16.1%, -4.2%; p < 0.001) | |
Zambia, 2006 [15]f, g |
SP
|
SP
|
SP
|
SP
|
32.8% (479/1457) | 20.4% (212/1040) | 64% (267/417) |
-43.6%
(-41.3%, -31.4%; p < 0.001) | |
QN
|
QN
|
QN
|
QN
| |
3.7% (54/1457) | 3.7% (28/1040) | 6.2% (26/417) |
-2.5%
(-5.3%, -0.7%; p = 0.003) |