title: Correlates of inappropriate prescribing of antibiotics to patients with malaria in Uganda.
abstract: BACKGROUND
  In many rural areas of Uganda, febrile patients presenting to health facilities are prescribed both antimalarials and antibiotics, contributing to the overuse of antibiotics. We identified the prevalence and correlates of inappropriate antibiotic management of patients with confirmed malaria.
  
  
  METHODS
  We utilized individual outpatient data from 36 health centers from January to September 2011. We identified patients who were prescribed antibiotics without an appropriate clinical indication, as well as patients who were not prescribed antibiotics when treatment was clinically indicated. Multivariate logistic regression models were used to identify clinical and operational factors associated with inappropriate case management.
  
  
  RESULTS
  Of the 45,591 patients with parasitological diagnosis of malaria, 40,870 (90%) did not have a clinical indication for antibiotic treatment. Within this group, 17,152 (42%) were inappropriately prescribed antibiotics. The odds of inappropriate prescribing were higher if the patient was less than five years old (aOR 1.96, 95% CI 1.75-2.19) and if the health provider had the fewest years of training (aOR 1.86, 95% CI 1.05-3.29). The odds of inappropriate prescribing were lower if patients had emergency triage status (aOR 0.75, 95% CI 0.59-0.96) or were HIV positive (aOR 0.31, 95% CI 0.20-0.45). Of the 4,721 (10%) patients with clinical indications for antibiotic treatment, 521 (11%) were inappropriately not prescribed antibiotics. Clinical officers were less likely than medical officers to inappropriately withhold antibiotics (aOR 0.54, 95% CI 0.29-0.98).
  
  
  CONCLUSIONS
  Over 40% of the antibiotic treatment in malaria positive patients is prescribed despite a lack of documented clinical indication. In addition, over 10% of patients with malaria and a clinical indication for antibiotics do not receive them. These findings should inform facility-level trainings and interventions to optimize patient care and slow trends of rising antibiotic resistance.
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington, United States of America ; Department of Epidemiology, University of Washington, Seattle, Washington, United States of America.
authors.forename: Arianna Rubin
authors.initials: AR
authors.lastname: Means
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington, United States of America.
authors.forename: Marcia R
authors.initials: MR
authors.lastname: Weaver
authors.affiliation: Accordia Global Health Foundation, Washington DC, United States of America ; Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Burnett
authors.affiliation: Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda ; Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium.
authors.forename: Martin K
authors.initials: MK
authors.lastname: Mbonye
authors.affiliation: Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda ; Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium.
authors.forename: Sarah
authors.initials: S
authors.lastname: Naikoba
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington, United States of America ; Department of Epidemiology, University of Washington, Seattle, Washington, United States of America ; Department of Medicine, University of Washington, Seattle, Washington, United States of America.
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000962:Antimalarials / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000941:ethics / Q000706:statistics & numerical data*; D008288:Malaria / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D010818:Practice Patterns, Physicians' / Q000941:ethics / Q000706:statistics & numerical data*; D014454:Uganda
chemical_list: D000900:Anti-Bacterial Agents; D000962:Antimalarials