title: Predictors of antibiotics co-prescription with antimalarials for patients presenting with fever in rural Tanzania.
abstract: BACKGROUND
  Successful implementation of malaria treatment policy depends on the prescription practices for patients with malaria. This paper describes prescription patterns and assesses factors associated with co-prescription of antibiotics and artemether-lumefantrine (AL) for patients presenting with fever in rural Tanzania.
  
  
  METHODS
  From June 2009 to September 2011, a cohort event monitoring program was conducted among all patients treated at 8 selected health facilities in Ifakara and Rufiji Health and Demographic Surveillance System (HDSS). It included all patients presenting with fever and prescribed with AL. Logistic regression was used to model the predictors on the outcome variable which is co-prescription of AL and antibiotics on a single clinical visit.
  
  
  RESULTS
  A cohort of 11,648 was recruited and followed up with 92% presenting with fever. Presumptive treatment was used in 56% of patients treated with AL. On average 2.4 (1 - 7) drugs was prescribed per encounter, indicating co-prescription of AL with other drugs. Children under five had higher odds of AL and antibiotics co-prescription (OR = 0.63, 95% CI: 0.46 - 0.85) than those aged more than five years. Patients testing negative had higher odds (OR = 2.22, 95% CI: 1.65 - 2.97) of AL and antibiotics co-prescription. Patients receiving treatment from dispensaries had higher odds (OR = 1.45, 95% CI: 0.84 - 2.30) of AL and antibiotics co-prescription than those served in health centres even though the deference was not statistically significant.
  
  
  CONCLUSIONS
  Regardless the fact that Malaria is declining but due to lack of laboratories and mRDT in most health facilities in the rural areas, clinicians are still treating malaria presumptively. This leads them to prescribe more drugs to treat all possibilities.
authors.affiliation: Ifakara Health Institute, P,O, Box 78373, Dar es Salaam, Tanzania. mnjozi@ihi.or.tz.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Njozi
authors.forename: Mbaraka
authors.initials: M
authors.lastname: Amuri
authors.forename: Majige
authors.initials: M
authors.lastname: Selemani
authors.forename: Irene
authors.initials: I
authors.lastname: Masanja
authors.forename: Brown
authors.initials: B
authors.lastname: Kigahe
authors.forename: Rashid
authors.initials: R
authors.lastname: Khatib
authors.forename: Dan
authors.initials: D
authors.lastname: Kajungu
authors.forename: Salim
authors.initials: S
authors.lastname: Abdula
authors.forename: Alexander N
authors.initials: AN
authors.lastname: Dodoo
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000962:Antimalarials / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data; D002675:Child, Preschool; D004338:Drug Combinations; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004983:Ethanolamines / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000188:drug therapy*; D005449:Fluorenes / Q000627:therapeutic use*; D006801:Humans; D008288:Malaria / Q000188:drug therapy; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D017150:Public Sector; D019035:Rural Health Services / Q000706:statistics & numerical data*; D013636:Tanzania; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes