title: Anti-malarial prescription practices among children admitted to six public hospitals in Uganda from 2011 to 2013.
abstract: BACKGROUND
  In 2011, Uganda's Ministry of Health switched policy from presumptive treatment of malaria to recommending parasitological diagnosis prior to treatment, resulting in an expansion of diagnostic services at all levels of public health facilities including hospitals. Despite this change, anti-malarial drugs are often prescribed even when test results are negative. Presented is data on anti-malarial prescription practices among hospitalized children who underwent diagnostic testing after adoption of new treatment guidelines.
  
  
  METHODS
  Anti-malarial prescription practices were collected as part of an inpatient malaria surveillance program generating high quality data among children admitted for any reason at government hospitals in six districts. A standardized medical record form was used to collect detailed patient information including presenting symptoms and signs, laboratory test results, admission and final diagnoses, treatments administered, and final outcome upon discharge.
  
  
  RESULTS
  Between July 2011 and December 2013, 58,095 children were admitted to the six hospitals (hospital range 3294-20,426).A total of 56,282 (96.9 %) patients were tested for malaria, of which 26,072 (46.3 %) tested positive (hospital range 5.9-57.3 %). Among those testing positive, only 84 (0.3 %) were first tested after admission and 295 of 30,389 (1.0 %) patients who tested negative at admission later tested positive. Of 30,210 children with only negative test results, 11,977 (39.6 %) were prescribed an anti-malarial (hospital range 14.5-53.6 %). The proportion of children with a negative test result who were prescribed an anti-malarial fluctuated over time and did not show a significant trend at any site with the exception of one hospital where a steady decline was observed. Among those with only negative test results, children 6-12 months of age (aOR 3.78; p < 0.001) and those greater than 12 months of age (aOR 4.89; p < 0.001) were more likely to be prescribed an anti-malarial compared to children less than 6 months of age. Children with findings suggestive of severe malaria were also more likely to be prescribed an anti-malarial after a negative test result (aOR 1.98; p < 0.001).
  
  
  CONCLUSIONS
  Despite high testing rates for malaria at all sites, prescription of anti-malarials to patients with negative test results remained high, with the exception of one site where a steady decline occurred.
authors: Infectious Diseases Research Collaboration, Kampala, Uganda. asadusserwanga@gmail.com.
authors: Asadu
authors: A
authors: Sserwanga
authors: Department of Medicine, San Francisco General Hospital, University of California, San Francisco, USA. dsears@labiomed.org.
authors: David
authors: D
authors: Sears
authors: Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, USA. bkapella@usaid.gov.
authors: Bryan K
authors: BK
authors: Kapella
authors: Infectious Diseases Research Collaboration, Kampala, Uganda. rkigozi@muucsf.org.
authors: Ruth
authors: R
authors: Kigozi
authors: National Malaria Control Programme, Ministry of Health Uganda, Kampala, Uganda. drubahika@yahoo.com.
authors: Denis
authors: D
authors: Rubahika
authors: Infectious Diseases Research Collaboration, Kampala, Uganda. sarah.staedke@lshtm.ac.uk.|London School of Hygiene and Tropical Medicine, London, UK. sarah.staedke@lshtm.ac.uk.
authors: Sarah G
authors: SG
authors: Staedke
authors: Infectious Diseases Research Collaboration, Kampala, Uganda. kamya@infocom.co.ug.|Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda. kamya@infocom.co.ug.
authors: Moses
authors: M
authors: Kamya
authors: Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, USA. say7@cdc.gov.
authors: Steven S
authors: SS
authors: Yoon
authors: Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, USA. aup6@cdc.gov.
authors: Michelle A
authors: MA
authors: Chang
authors: Department of Medicine, San Francisco General Hospital, University of California, San Francisco, USA. gdorsey@medsfgh.ucsf.edu.
authors: Grant
authors: G
authors: Dorsey
authors: Infectious Diseases Research Collaboration, Kampala, Uganda. arthurwakg@yahoo.com.|Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda. arthurwakg@yahoo.com.
authors: Arthur
authors: A
authors: Mpimbaza
mesh_terms: D000293:Adolescent; D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D006760:Hospitalization / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology; D055656:Prescriptions / Q000706:statistics & numerical data*; D062486:Public Health Surveillance; D014454:Uganda / Q000453:epidemiology
chemical_list: D000962:Antimalarials