title: Antibiotic prescribing practices for patients with fever in the transition from presumptive treatment of malaria to 'confirm and treat' in Zambia: a cross-sectional study.
abstract: OBJECTIVE
  To evaluate antibiotic use among patients presenting to primary healthcare facilities with febrile illness in Zambia.
  
  
  METHODS
  We analysed data from a 2011 nationwide cross-sectional health facility survey of routine malaria case management in Zambia. Patient consultation observation and medical record charts were used to calculate the proportion of febrile patients who were prescribed antibiotics, stratified by symptoms, health workers' diagnosis and malaria test results. Logistic regression was used to identify factors affecting antibiotic prescribing behaviour.
  
  
  RESULTS
  Of 872 patients presenting with fever, 651 (74.6%) were tested for malaria. Among those tested, 608 (93.4%) had analysable results; 230 (37.8%) had positive results. Antibiotics were prescribed to 69/230 (30.0%), 247/378 (65.3%) and 132/221 (59.7%) of those who tested positive, negative and those 'not tested', respectively. Furthermore, antibiotics were prescribed to 36/59 (61.0%) and 242/322 (75.1%) of those diagnosed with diarrhoea and upper respiratory tract infection (URTI), respectively. Among patients prescribed any antibiotic, concurrent antimalarial prescribing occurred in 66/69 (95.6%), 32/247 (12.9%) and 19/132 (14.4%) for those with positive results, negative results and 'not tested', respectively. Respiratory symptoms, diagnosis of URTI, malaria or skin disease and level of health care in the health delivery system were associated with antibiotic prescribing.
  
  
  CONCLUSIONS
  Testing positive for malaria or receiving a malaria diagnosis was associated with reduced antibiotic prescribing, while testing negative, not being tested or a diagnosis of URTI resulted in higher rates of antibiotic prescribing. There is a need for improving diagnostic capacity for non-malaria causes of febrile illness at healthcare delivery points and limiting antibiotic use to patients with definite bacterial infections.
authors: Chainama College of Health Sciences, Lusaka, Zambia.
authors: Micky
authors: M
authors: Ndhlovu
authors: Chainama College of Health Sciences, Lusaka, Zambia.
authors: Emmy
authors: E
authors: Nkhama
authors: PATH Malaria Control and Elimination Partnership in Africa, National Malaria Control Centre, Lusaka, Zambia.
authors: John M
authors: JM
authors: Miller
authors: Zambia Center for Applied Health Research & Development, Lusaka, Zambia.|Center for Global Health & Development, Boston University School of Public Health, Boston, MA, USA.|Department of Global Health, Boston University School of Public Health, Boston, MA, USA.|Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA.
authors: Davidson H
authors: DH
authors: Hamer
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000962:Antimalarials / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D019090:Case Management; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine; D011307:Drug Prescriptions; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007159:Immunologic Tests; D007223:Infant; D016015:Logistic Models; D008288:Malaria / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D015024:Zambia
chemical_list: D000900:Anti-Bacterial Agents; D000962:Antimalarials
keywords: Zambia; antibiotic; fever; malaria; prescribing