Abstract：
INTRODUCTION:With the ability to diagnose malaria with rapid diagnostic tests (mRDT), interest in improving diagnostics for non-malarial fevers has increased. Understanding how health providers diagnose and treat fevers is important for identifying additional tools to improve outcomes and reduce unnecessary antibiotic prescribing, particularly in areas where access to laboratory diagnostics is limited. This study aimed to understand rural health providers' practice patterns, both quantitatively and qualitatively, and influences on diagnostic and treatment decision-making. METHODS:A mixed-methods study was conducted in Mulanje and Phalombe districts in southern Malawi. Retrospective data on diagnoses and treatments of febrile illness from seven mobile clinic logbooks were collected for a 2-month period in both the dry and wet seasons. Mobile health clinics visited remote villages in southern Malawi once every 7 days. Records from all patients with a recorded axillary temperature of 37.5ºC or higher or reported history of fever within 48 hours, and a negative mRDT, were included in the analysis. Key informant interviews were conducted with 31 mobile clinic health workers who triage, diagnose, and treat patients as well as dispense medication. RESULTS:In total, 30 672 febrile patients were seen during the study period. Of those, 9924 (32%) tested negative for malaria by mRDT. Acute respiratory infection was the most common diagnosis for mRDT-negative patients (44.6%), and this number increased in the rainy season as compared to the dry season (odds ratio=2.18, 95% confidence interval=2.01-2.36). Over half (60%) of mRDT-negative patients received antibiotics as a treatment. Almost all the health providers in this study reported limited training in non-malarial fever management, despite the fact that roughly 30% of all patients with fever seen at the mobile clinics tested negative by mRDT. Without diagnostic tools beyond mRDTs, providers relied heavily on patient history to guide treatment decisions. CONCLUSION:Additional simple-to-use diagnostic tests as well as additional training in patient examination and clinical assessment are needed in rural settings where health providers risk over-prescribing antibiotics or missing a potentially dangerous infection in febrile patients who test negative for malaria.
journal_name
Rural Remote Healthjournal_title
Rural and remote healthauthors
Baltzell K,Kortz TB,Scarr E,Blair A,Mguntha A,Bandawe G,Schell E,Rankin Sdoi
10.22605/RRH4818subject
Has Abstractpub_date
2019-06-01 00:00:00pages
4818issue
2issn
1445-6354pii
4818journal_volume
19pub_type
杂志文章abstract：INTRODUCTION:The Australian Rural Clinical Schools, established nationally in 2000-2001, have provided an opportunity for medical students to undertake their clinical training across a network of hospitals, general practice surgeries and community medical centres in locations throughout Australia. The Rural Clinical Sc...
journal_title：Rural and remote health
pub_type： 杂志文章
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更新日期：2006-01-01 00:00:00
abstract：INTRODUCTION:There is evidence in the literature that rural background significantly encourages eventual rural practice. Given the shortage of healthcare providers in rural areas, we need to explore ways of ensuring throughput and success of rural-origin students in health sciences. It is therefore important to underst...
journal_title：Rural and remote health
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更新日期：2012-01-01 00:00:00
abstract：INTRODUCTION:Occupational noise injury and hearing loss are common features of agricultural workforces internationally. Farmsafe Australia has identified hearing health as one of its 4 key priority goals and targets. Currently, approximately 60-70% of Australian farmers have measurable hearing loss, compared with 27% o...
journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2010-01-01 00:00:00
abstract：INTRODUCTION:Rates of mental health issues are increasing, coupled with insufficient resources to provide appropriate support. This is a particular challenge for rural areas in Australia that face significant social inequities including a scarcity of health resources. E-health initiatives are often proposed to maximise...
journal_title：Rural and remote health
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journal_title：Rural and remote health
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journal_title：Rural and remote health
pub_type： 杂志文章,评审
doi：
更新日期：2016-10-01 00:00:00
abstract：INTRODUCTION:Diabetes is a growing worldwide problem, characterized by considerable ethnic variation and being particularly common in modernizing populations. Modernization is accompanied by a variety of stressful sociocultural changes that are believed to increase the risk of diabetes. Unfortunately, there is little a...
journal_title：Rural and remote health
pub_type： 杂志文章,评审
doi：
更新日期：2011-01-01 00:00:00
abstract：CONTEXT:Entry to practice medical programs (graduate- and undergraduate-entry) in Australia are under considerable pressure to provide clinical training as a result of increased student numbers. At the same time modern medical curricula require the development of active placements in expanded settings to achieve gradua...
journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2011-01-01 00:00:00
abstract：:The School of Rural Health is an initiative of the Australian Commonwealth Government, the University of New South Wales, Australia, and the Greater Murray Area Health Service. The school was established in February 2000 to facilitate the recruitment of doctors to and their retention in rural areas. The school is resp...
journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2003-07-01 00:00:00
abstract：INTRODUCTION:Locally and internationally, there have been renewed calls for equitable access to healthcare services. Simultaneously, caseloads have become more challenging and contexts more complex, which may be overwhelming to new graduates. The South African context offers a particularly interesting example of these ...
journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2013-01-01 00:00:00
abstract：INTRODUCTION:Road traffic crashes constitute a considerable public health burden and represent the eighth leading cause of death and tenth leading cause of disability adjusted life years (DALYs) globally. However, very little is known about the extent, causes and impact of crashes in low- and middle-income countries in...
journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2015-07-01 00:00:00
abstract：INTRODUCTION:Although some characteristics of physicians are known to be associated with their recruitment in rural and remote areas, the factors that predict mobility of physicians, and in particular, their mobility to rural and distant areas are largely unknown. METHODS:Flows of all physicians (n=4268) among municip...
journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2012-01-01 00:00:00
abstract：INTRODUCTION:The Nurse Practitioner - Aged Care Models of Practice Initiative supported the roll-out of a range of nurse practitioner (NP) models of practice, across Australia. One of these models was a community-based clinic-located practice, situated in a remote tourist destination where there is no resident general ...
journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2016-04-01 00:00:00
abstract：INTRODUCTION:The chronic diseases associated with overweight and obesity are major contributors to the excess disease burden of Aboriginal Australians. Surveillance of overweight and obesity is required to monitor these conditions, and to develop and evaluate interventions to improve health and wellbeing. Remote Aborig...
journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2012-01-01 00:00:00
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journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2016-10-01 00:00:00
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journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2015-07-01 00:00:00
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journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2010-01-01 00:00:00
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journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2007-04-01 00:00:00
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journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2005-04-01 00:00:00
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journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2009-04-01 00:00:00
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journal_title：Rural and remote health
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doi：
更新日期：2014-01-01 00:00:00
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journal_title：Rural and remote health
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journal_title：Rural and remote health
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更新日期：2017-10-01 00:00:00
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journal_title：Rural and remote health
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doi：
更新日期：2012-10-01 00:00:00
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journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2008-07-01 00:00:00
abstract：:Rural and Remote Health is committed to the task of providing a freely accessible, international, peer-reviewed evidence base for rural and remote health practice. Inherent in this aim is a recognition of the universal nature of rural health issues that transcends local culture and regional interests. While RRH is alr...
journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2003-01-01 00:00:00
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journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2012-01-01 00:00:00
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journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2013-10-01 00:00:00
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journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2010-10-01 00:00:00
abstract：INTRODUCTION:Time spent in remote medicine as an undergraduate is influential in career choice in Australia and Northern America. However, its influence is not known in smaller countries, where recruitment into rural medicine is also problematic. Differences across countries mean work is required to explore determinant...
journal_title：Rural and remote health
pub_type： 杂志文章
doi：
更新日期：2008-07-01 00:00:00
