title: Factors Associated with Testing and Prompt Use of Recommended Antimalarials following Malaria Diagnosis: A Secondary Analysis of 2011-12 Tanzania HIV and Malaria Indicator Survey Data.
abstract: BACKGROUND
  Malaria is still a public health problem in Sub-Saharan Africa. Malaria causes mortality mostly in children under-five years. Early detection and prompt treatment using recommended antimalarials is key to malaria control. However, in Tanzania, contrary to the national goals, a large proportion of children with fever taken to health facilities are not tested for malaria and those tested positive are not promptly treated using recommended antimalarials. The aim of this study was to determine factors associated with malaria testing and prompt use of recommended antimalarials among under-five children with fever in Tanzania.
  
  
  METHODS
  This was a secondary analysis of Tanzania HIV and Malaria Indicator Survey (THMIS) data 2011-12 obtained from a national cross sectional survey. The analysis involved children aged 6-59 months whose mothers reported they had fever two weeks preceding the survey. Factors associated with testing and uses of recommended antimalarials were obtained using logistic regression.
  
  
  RESULTS
  Of the 1675 under-five children with fever, 951 (56.8%) were taken to the health facilities. Of the 951 children, only 394 (41.48%) febrile children were tested for malaria. Of those tested, 291 (78.91%) were diagnosed with malaria. Of those diagnosed with malaria, only 124 (42.68%) children used recommended antimalarials within 1st 24 hours of diagnosis. In multivariate analysis, children taken to health centers (OR 1.79; 95%CI: 1.07-3.00) and to the hospitals (OR 3.4; 95%CI: 1.75-6.77) had higher odds of being tested compared to those taken to dispensary and other lower level health facilities. Children were more likely to use recommended antimalarial promptly if they had a caretaker with secondary or higher education (OR: 4.07; 95%CI: 0.61-2.68) or living in the rural area (OR: 3.21; 95%CI: 1.09-9.44) compared to those with an uneducated caretaker or from an urban area.
  
  
  CONCLUSIONS
  Training on malaria testing and treatment guidelines should be provided, and preventing stock outs of malaria testing kits and medications at dispensary level should be made available as it is the first point of health care for most Tanzanians. Reasons on why urban people are less likely to use recommended antimalarials need to be investigated and addressed for proper malaria management.
authors.affiliation: Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMU Co), Moshi, Tanzania; Institute of Public Health, Department of Community Health, Kilimanjaro Christian Medical University College (KCMU Co), Moshi, Tanzania; Department of Community Health, Kilimanjaro Christian Medical Centre (KCMC) Hospital, Moshi, Tanzania; Assistant Medical Officer (AMO)-General Teaching College, KCMC Hospital, Moshi, Tanzania.
authors.forename: Juma
authors.initials: J
authors.lastname: Adinan
authors.affiliation: Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMU Co), Moshi, Tanzania; Institute of Public Health, Department of Community Health, Kilimanjaro Christian Medical University College (KCMU Co), Moshi, Tanzania; Department of Community Health, Kilimanjaro Christian Medical Centre (KCMC) Hospital, Moshi, Tanzania.
authors.forename: Damian J
authors.initials: DJ
authors.lastname: Damian
authors.affiliation: Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMU Co), Moshi, Tanzania; Institute of Public Health, Department of Community Health, Kilimanjaro Christian Medical University College (KCMU Co), Moshi, Tanzania; Department of Community Health, Kilimanjaro Christian Medical Centre (KCMC) Hospital, Moshi, Tanzania.
authors.forename: Sia E
authors.initials: SE
authors.lastname: Msuya
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care; D003710:Demography; D005260:Female; D005334:Fever / Q000209:etiology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006306:Health Surveys; D006801:Humans; D007223:Infant; D008288:Malaria / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D012307:Risk Factors
chemical_list: D000962:Antimalarials