title: Malaria prevalence and treatment of febrile patients at health facilities and medicine retailers in Cameroon.
abstract: OBJECTIVE
  To investigate the quality of malaria case management in Cameroon 5 years after the adoption of artemisinin-based combination therapy (ACT). Treatment patterns were examined in different types of facility, and the factors associated with being prescribed or receiving an ACT were investigated.
  
  
  METHODS
  A cross-sectional cluster survey was conducted among individuals of all ages who left public and private health facilities and medicine retailers in Cameroon and who reported seeking treatment for a fever. Prevalence of malaria was determined by rapid diagnostic tests (RDTs) in consenting patients attending the facilities and medicine retailers.
  
  
  RESULTS
  Among the patients, 73% were prescribed or received an antimalarial, and 51% were prescribed or received an ACT. Treatment provided to patients significantly differed by type of facility: 65% of patients at public facilities, 55% of patients at private facilities and 45% of patients at medicine retailers were prescribed or received an ACT (P = 0.023). The odds of a febrile patient being prescribed or receiving an ACT were significantly higher for patients who asked for an ACT (OR = 24.1, P < 0.001), were examined by the health worker (OR = 1.88, P = 0.021), had not previously sought an antimalarial for the illness (OR = 2.29, P = 0.001) and sought treatment at a public (OR = 3.55) or private facility (OR = 1.99, P = 0.003). Malaria was confirmed in 29% of patients and 70% of patients with a negative result were prescribed or received an antimalarial.
  
  
  CONCLUSIONS
  Malaria case management could be improved. Symptomatic diagnosis is inefficient because two-thirds of febrile patients do not have malaria. Government plans to extend malaria testing should promote rational use of ACT; though, the introduction of rapid diagnostic testing needs to be accompanied by updated clinical guidelines that provide clear guidance for the treatment of patients with negative test results.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK. Lindsay.mangham@lshtm.ac.uk
authors.forename: Lindsay J
authors.initials: LJ
authors.lastname: Mangham
authors.forename: Bonnie
authors.initials: B
authors.lastname: Cundill
authors.forename: Olivia A
authors.initials: OA
authors.lastname: Achonduh
authors.forename: Joel N
authors.initials: JN
authors.lastname: Ambebila
authors.forename: Albertine K
authors.initials: AK
authors.lastname: Lele
authors.forename: Theresia N
authors.initials: TN
authors.lastname: Metoh
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Ndive
authors.forename: Ignatius C
authors.initials: IC
authors.lastname: Ndong
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Nguela
authors.forename: Akindeh M
authors.initials: AM
authors.lastname: Nji
authors.forename: Barnabas
authors.initials: B
authors.lastname: Orang-Ojong
authors.forename: Virginia
authors.initials: V
authors.lastname: Wiseman
authors.forename: Joelle
authors.initials: J
authors.lastname: Pamen-Ngako
authors.forename: Wilfred F
authors.initials: WF
authors.lastname: Mbacham
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D002163:Cameroon / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003132:Commerce; D003430:Cross-Sectional Studies; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006268:Health Facilities / Q000191:economics; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D010594:Pharmacies; D010808:Physical Examination; D010936:Plant Extracts / Q000627:therapeutic use*; D055656:Prescriptions; D015995:Prevalence; D017149:Private Sector; D017150:Public Sector; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D010936:Plant Extracts; C031327:artemisinin