Factors Influencing the Acceptability of the Test, Treat and Refer Practice for Malaria among Caregivers of Under 5 Children at Community Pharmacies and Drug Shops in Nigeria

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Akomolafe, Sikiru Baruwa, Emeka Emmanuel Okafor, Ene Daniel-Ebune, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3937247/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Oct, 2024 Read the published version in Malaria Journal → Version 1 posted 7 You are reading this latest preprint version Abstract Background The burden of malaria affects children under the age of five and pregnant women, leading to high morbidity and mortality rates. In sub-Saharan Africa, Patent and Proprietary Medicine Vendors (PPMVs) have been identified as key players in the provision of malaria treatment due to their accessibility and availability in communities, but PPMVs are not usually tested before fever cases are treated as malaria or refer clients. The aim of this study was to explore the factors influencing caregivers’ acceptance of the test, treatment and referral practices for malaria management provided by CPs and PPMVs in Kaduna and Lagos states, Nigeria. Methods A cross-sectional quantitative telephone survey was conducted among 150 caregivers of children under five years old who received malaria services from trained CPs and PPMVs between May and July 2022. Descriptive and bivariate analyses were performed to identify factors significantly associated with the acceptability of malaria management services. All statistically significant factors from the bivariate analysis were explored using logistic regression models, and odds ratios (ORs) with confidence intervals (CIs) were calculated to predict acceptability. The 95% level was used to define statistically significant associations (p ≤ 0.05). Results All caregivers were asked questions that aided in obtaining a diagnosis of malaria. More than two-thirds of the caregivers (68%) reported that the child was tested by a CP/PPMV. Among those treated (148), 89% reported that the child was administered artemisinin combination therapy (ACT) irrespective of whether the child tested positive or negative for malaria. At the bivariate level, acceptability was greater among caregivers of children aged 13 months and older than among caregivers of children aged 0–12 months (93% vs. 76%, p = 0.004). Caregivers of children prescribed ACT had greater acceptance than did those not prescribed ACT (92% vs. 69%, p = 0.010). Multivariate analysis revealed that these relationships held. Conclusions The adoption of the test, treat, and refer practice as a standard approach by CPs and PPMVs could replace the widespread practice of prescribing medications without conducting tests. This shift has the potential to improve the quality of malaria management services and enhance patient outcomes. Malaria Nigeria community pharmacist drug shop owners private sector acceptability Introduction In 2010, the World Health Organization revised protocols for malaria treatment guidelines that recommended screening for malaria infection before treatment ( 1 ). Because the use of microscopy is limited in most healthcare facilities in Sub-Saharan Africa (SSA), rapid diagnostic tests (RDTs) are recommended for test-based management of malaria ( 1 ). The burden of malaria affects children under the age of five and pregnant women, leading to high morbidity and mortality rates ( 2 , 3 ). Approximately, 67% (272,000) of global malaria deaths were among children under five years of age ( 2 ). A major explanation for this difference was that infants and young children under five years of age are at high risk of clinical episodes from their low or no protective immune mechanism against malaria infection ( 2 , 4 , 5 ). Most studies have shown that children under two years of age ( 6 – 11 ) are at increased risk of malaria infection. Among under five children, the negative consequences of malaria manifest in the form of chronic anemia, low birth weight, reduced growth, and other cases of severe intellectual disabilities ( 12 – 14 ). Globally, Nigeria has the highest number of malaria cases and deaths, accounting for approximately 27% of all malaria cases and 23% of all malaria deaths ( 2 ). According to the 2019 World Malaria Report, Nigeria reported an estimated 25% increase in malaria cases between 2015 and 2019 ( 2 ). The WHO introduced the use of malaria Rapid Diagnostic Tests (mRDT) kits to increase the accuracy and improve confidence in malaria diagnosis, and this approach has been reported to reduce misdiagnosis and management of malaria cases ( 15 ). In Nigeria, the National Malaria Elimination Program (NMEP) has prioritized the deployment of mRDTs as a cost-effective method for diagnosing malaria at primary healthcare facilities ( 16 ). This strategy allows for quick and reliable diagnosis without requiring specialized laboratory equipment or trained personnel. Collaborations with international organizations and donor agencies have ensured the availability and distribution of RDTs across the country ( 16 ). Effective treatment of malaria requires the use of appropriate antimalarial drugs based on accurate diagnosis and consideration of factors such as drug resistance patterns and patient characteristics ( 1 ). Artemisinin-based combination therapy (ACT) is recommended as the first-line treatment for uncomplicated malaria. However, the availability and accessibility of ACT, as well as the appropriate use of antimalarial drugs, remain challenges in sub-Saharan Africa, including Nigeria ( 1 ). The use of substandard or counterfeit antimalarial drugs in Nigeria has health and economic impacts, contributing to treatment failure and prolonged illness ( 17 ). Improving the diagnosis and treatment of malaria will not only improve treatment outcomes but also assist in rationalizing healthcare costs by reducing the consumption and resistance of antimalarial drugs ( 18 – 20 ). The pertinent literature has revealed that the roll-out of mRDTs in health facilities can reduce the overprescription of antimalarials ( 21 – 23 ) and treat those with positive results in line with the appropriate treatment guidelines. However, facility-based providers are not the only source of treatment for febrile illness, or even the main source in many settings ( 24 – 29 ). Several studies have highlighted the potential benefits of engaging patent and proprietary medicine vendors (PPMVs), who are operators of drug shops in the fight against malaria, as well as increased access to clients ( 28 , 30 ). In sub-Saharan Africa, PPMVs have been identified as key players in the provision of malaria treatment due to their accessibility and availability in communities. Studies conducted in Nigeria have shown that compared with public health facilities, PPMVs are the preferred source of malaria treatment for many people due to their proximity and longer operating hours and that they play a critical role in the provision of ACTs for malaria treatment ( 31 , 32 ). A study conducted in Tanzania revealed that PPMVs were the most common health facility providers visited for fever-related illnesses, including malaria, in rural areas ( 33 , 34 ). Similarly, a study in Kenya showed that PPMVs were the most commonly used healthcare providers for malaria treatment, especially in rural areas with limited access to healthcare facilities ( 35 ). In many countries in sub-Saharan Africa, formal and informal health systems including the communities, are now using RDTs to guide malaria treatment decisions in routine care ( 36 ). In Nigeria, to reduce misdiagnosis and treatment of malaria in the informal sector, the government permitted Community Pharmacists (CPs) and PPMVs to administer RDTs as part of new guidelines for integrated management of childhood illnesses and malaria ( 37 ). Some studies have documented the acceptability of deploying RDTs to confirm the diagnosis of malaria in community settings among community health workers ( 29 , 38 ), but very little evidence is available on the varying factors that influence the acceptability of malaria testing among caregivers of children under five years of age, especially among CPs and PPMVs who are for profit-making ( 39 , 40 ). More evidence is needed in this regard, as we know that behavioral change, especially for health-seeking individuals, depends on a number of factors, such as individuals’ perceptions of health benefits, the characteristics of the individuals who may adopt the change, and contextual factors within the community ( 41 , 42 , 43 ). Understanding these factors and their influence on health-seeking behavior from the caregivers’ point of view is critical and relevant to understanding the receptibility of RDTs for diagnosing malaria before treating children younger than five years in the hands of CPs and PPMVs. The aim of this study was therefore to explore the factors likely to influence caregivers’ acceptance of the test, treatment and referral practices by CPs and PPMVs within the context of community case management of fever in children under five years of age in Nigeria. Methods Intervention IntegratE 2.0 has the goal of improving the retail private sector's delivery of family planning (FP) and a selection of primary healthcare (PHC) services through standardized training. These PHC services include the management of malaria, pneumonia, diarrhea, nutritional status, and tuberculosis. Supported by the Bill & Melinda Gates Foundation, the project collaborates with the Pharmacy Council of Nigeria (PCN) and other stakeholders to pilot, integrate, and increase the provision and access to quality FP and PHC services by CPs and PPMVs across 11 Nigerian states. The project adopted a tiered accreditation system in which PCN categorized PPMVs into three tiers based on their education and health qualifications. This categorization also determines the type of FP training received and the services provided. Those without health-related qualifications were categorized as Tier 1, those with educational backgrounds that the PCN deemed to be health-related (e.g., Nursing and Midwifery, or Community Health Extension) were categorized as Tier 2, and those with pharmacy technician certificates were categorized as Tier 3. Under the pilot 3-tier accreditation system, Tier 1 PPMVs participated in 12-day training at PCN-accredited schools of health technology; and topics in PHC services (malaria, diarrhea, pneumonia); in FP counseling; in the provision of condoms, cycle beads and oral contraceptive refills; in referrals for FP methods; and in documenting FP services were covered. Tier 2 and Tier 3 PPMVs received the same training as Tier 1 PPMVs plus an additional 3 days of training on injectable administration and implant insertion and removal. PCN staggered training days for 4 and 5 weeks for tier 1 PPMVs and tier 2 and 3 PPMVs, respectively. PCN organized a training of trainers (ToT) for accredited schools of health technology on the 3-tier accreditation approach. On the other hand, CPs have a pharmacy degree, and PCN register and license them. Therefore, they function outside of the pilot accreditation system but receive the same training as Tier 2 and Tier 3 PPMVs. Between January and September 2022, as part of Integrated Community Case Management (ICCM) training, CPs and PPMVs received training in malaria case management, including how to recognize common symptoms in children, perform the malaria Rapid Diagnostic Test (mRDT) accurately, administer appropriate treatment using Artemisinin-based Combination Therapy (ACT) after a positive mRDT result and identify severe signs and symptoms of other febrile illnesses that should be referred to the nearest health facility for further investigation and management. Study sites. The implementation of the IntegratE project commenced in Lagos and Kaduna states in 2018. The project trained CPs and PPMVs on malaria case management in 2022. Lagos State, with a population of 9,013,534, is in the southwestern part of Nigeria (44), while Kaduna State, with a population of 6,113,503, is in the northern part of the country (44). According to the 2018 Nigeria Demographic and Health Survey, the prevalence of malaria in children is lower in Lagos State (3.4%) than in Kaduna State (34.3%) (44). We conducted exit interviews among caregivers of under five children after providers had settled into their new role of providing malaria services in line with the national malaria treatment guidelines. The malaria treatment guidelines in Nigeria recommend screening individuals who have a history of fever in the past 48 hours with an mRDT kit or microscopy, followed by treatment with artemisinin-based combination therapy if the test results are positive. Study Design and Sampling We conducted a cross-sectional quantitative telephone survey among caregivers of children under-five years of age who received malaria services from IntegratE-trained CPs and PPMVs to determine their acceptance of the WHO “test, treat and refer” practices for malaria in Kaduna and Lagos states. Using the study tool, we interviewed a total of 150 caregivers of children under five years old who received malaria services from CPs and PPMVs in the two states: seventy-five in Lagos and seventy-five in Kaduna. CPs and PPMVs informed their clients about the study and requested their permission to share their details, including phone numbers, with the IntegratE Research, Monitoring, and Evaluation (RME) team. Data collection To facilitate this research, we trained four interviewers in research ethics, study design and objectives, procedures for administering informed consent forms, and telephone interview techniques. We interviewed caregivers of under 5 children who received malaria treatment from CPs and PPMVs from May to July 2022 to gather evidence on the process and perception of treatment received from these providers, adherence to treatment guidelines and referral of clients to health facilities when appropriate. The interviewers called caregivers who agreed to share their information with the research team to confirm their eligibility. Eligible respondents were caregivers of under 5 children who received malaria services from a trained CP or PPMV and owned a cell phone. If eligible, trained data collectors provided potential respondents with details of the study, including the objectives, what we expected of them as respondents, and potential risks and benefits of participation. They interviewed those who agreed over the phone and compensated them with 1000 Naira (approximately 1.39 USD) in phone credit. The interviewers used tablets to administer a quantitative interview that included questions on sociodemographic characteristics; perception and acceptability of the malaria test; treatment and referral from the CP or PPMV; and general experiences receiving malaria services from the CP or PPMV. The interviewers recorded their responses on tablets using the Kobo toolbox app to facilitate timely submission and analysis of the data. The results were explored by examining relevant characteristics such as provider type, state, age, marital status, and parity. Measures Dependent variable We measured the dependent variable, acceptability of the services received from CPs and PPMVs using their level of satisfaction. Using a Likert scale, we asked caregivers if they were: very satisfied, satisfied, somewhat satisfied, somewhat unsatisfied or not satisfied at all with the services received from the CP/PPMV. Responses were dichotomized as high satisfaction (very satisfied and satisfied) or low satisfaction (somewhat satisfied, somewhat unsatisfied, not satisfied at all) for the analysis. Independent variables The demographic characteristics of the caregivers included age, marital status, education level, employment status, and the household wealth index. We included the age and sex of the sick child in the demographic data. We grouped the ages of the caregivers into three categories: 15–24 years, 25–34 years, and 35 years and older. We categorized marital status into two categories: not married and married. We grouped the education level of the caregivers into four categories: primary school or less, secondary, and two plus years postsecondary. We categorized employment status as unemployed or employed. The household wealth index was measured using a composite score calculated using principal component analysis of household asset items and then categorized into the lowest, middle, and highest scores. We grouped the ages of the sick children into two groups: 0–12 months and 13 months and older. Other independent variables included the time of presentation to the CP/PPMV, testing using mRDT, test results, ACT prescription, and 5 attitudinal questions. Statistical analysis We exported the data into Stata version 16.1 for analysis. The results were explored by examining relevant characteristics such as provider type, state, age, marital status, and parity. Descriptive analysis of demographic characteristics and the use of malaria testing, treatment using ACT and referral services was performed using frequencies. Bivariate analysis was also conducted to identify factors significantly associated with acceptance of malaria management services. Associations between factors and acceptability were tested using the chi-square (χ2) test. The 95% level was used to define statistically significant associations (p ≤ 0.05) for further consideration. All statistically significant factors from the bivariate analysis were explored using logistic regression models and odds ratios (ORs) with confidence intervals (CIs) were calculated to predict acceptability. Variables associated with acceptability according to bivariate analysis, such as malaria treatment practices (testing, prescription of ACT) were included in a logistic regression model to adjust for confounding variables. Ethics Approval The study was approved by the Institutional Review Board (IRB) of the Population Council (Protocol 878) and the National Health Research Ethics Committee (NHREC) of the Federal Ministry of Health. Informed consent was obtained from all clients in line with relevant guidelines as approved by both ethical committees. Results Table 1 presents the demographic profile of caregivers of children under five years of age who visited CPs and PPMVs for malaria treatment. We interviewed a total of 150 female caregivers in the survey. The mean age of the caregivers was 32 years (range 18–49), the majority (94%) were aged 25 years and above, and 93% of the caregivers were married or in a union. Approximately 87% had at least secondary education, 80% were employed, and 42% were in the middle-income bracket. Table 1 Respondent characteristics Characteristics n % Sex of sick child Male 82 54.7 Female 68 45.3 Age of sick child (in months) 0–12 months 33 22.0 13 months or more 117 78.0 Mean age of sick child (in months) 30.93 Age of caregiver 18–24 years 9 6.0 25 years and above 141 94.0 Mean age of caregiver (In years) 32.49 Marital Status Not Married 11 7.3 Married 139 92.7 Highest level of education achieved Primary school or less 19 12.7 Secondary 62 41.3 2 + years postsecondary 69 46.0 Employment status Unemployed 30 20.0 Employed 120 80.0 Wealth Index Lowest 50 33.3 Middle 63 42.0 Highest 37 24.7 Table 2 shows the results of malaria testing, treatment with ACT and referral. Most caregivers (93%) reported seeking treatment for a child within 6 days of onset of illness, and less than half (45%) sought advice or treatment the same day or next day (data not shown). All caregivers were asked questions that aided in obtaining a diagnosis of malaria. Ninety-nine percent (99%) of the caregivers were asked about signs and symptoms by CP/PPMV, 97% reported that CP/PPMV felt for fever or took the child’s temperature, and 97% of the caregivers were asked about the duration of fever. More than two-thirds of the caregivers (68%) reported that their child had blood taken from a finger or heel for testing by CP/PPMV. Of the 102 caregivers who responded to the question “What was the result of the malaria test?”, 97% reported that the child tested positive for malaria. Of the 148 caregivers who reported that CP/PPMV administered or prescribed drugs for a child, 89% reported that the child was administered artemisinin combination therapy (ACT) irrespective of whether the child tested positive or negative for malaria (Table 2 ). Among those who tested positive for malaria (n = 93), 88% were administered ACT. Among caregivers whose children were administered ACT (n = 132), 72.0% were asked to return for a follow-up visit after treatment. Only 5% of caregivers reported that the child was referred to another facility for treatment (Table 2 ), and 6 out of 7 caregivers reported that the child was taken to the referral facility (data not shown). Table 2 Uptake of malaria test, treatment using ACT, and referral n % Time of presentation to CP/PPMV after the onset of symptoms 7 days or more 11 7.3 Less than 7 days 139 92.7 Questions that aid in Malaria diagnosis CP/PPMV asked about signs and symptoms 148 98.7 CP/PPMV felt for fever or took the child’s temperature 146 97.3 CP/PPMV asked for duration of fever 146 97.3 Blood taken from sick finger or heel for testing by CP/PPMV Yes 102 68.0 No 48 32.0 Test result Not tested 48 32.0 mRDT negative 9 6.0 mRDT positive 93 62.0 ACT prescription by CP/PPMV* ACT not prescribed 16 10.8 ACT prescribed 132 89.2 Tested positive and treated with ACT (n = 93) Yes 82 88.2 No 11 11.8 Advised to return for follow-up visit (n = 132) Yes 95 72.0 No 37 28.0 Referred to a health facility Yes 7 4.7 No 143 95.3 Would visit the same CP/PPMV, next time child is sick Yes 146 97.3 No 4 2.7 Will recommend CP/PPMV to a friend seeking treatment Yes 148 98.7 No 2 1.3 Enthusiastic about the availability of a test for malaria at the CP/PPMV Not enthusiastic 130 86.7 Enthusiastic 20 13.3 Attitude toward testing Receiving a malaria test from the CP/PPMV store reduced the burden of telling the CP/PPMV about my child's symptoms Disagree 31 20.7 Agree 119 79.3 A malaria test result provides an objective assessment of what was wrong with my child Disagree 19 12.7 Agree 131 87.3 It was beneficial that my child was tested for malaria at the CP/PPMV shop Disagree 34 22.7 Agree 116 77.3 Ever chosen not to test child for malaria when they were offered the test Yes 15 10.0 No 135 90.0 Will be worried if child was denied Artemisinin-based combination therapies (ACTs) Yes 99 66.0 No 51 34.0 Acceptability and perception of the test, treat and refer practice . Eighty-nine percent of the caregivers reported high acceptability of the services they received. Most caregivers (88%) were happy with the “form of healthcare” received, 67% with the “type of medicine” received, and 61% were happy with the use of the mRDT test. Eighty-eight percent of caregivers considered that it was important to test before treating for malaria, and 45% did not expect a blood test (mRDT) from a CP/PPMV (data not shown). Caregivers (97%) indicated that they would visit the CP/PPMV during the child’s next sick episode, and 99% would recommend the provider to friends seeking care. Only 10% of caregivers had chosen not to test a child for malaria at one time when they were offered the test. Approximately two-thirds (66%) of caregivers would be worried if provider denied the child treatment using ACT (Table 2 ). We examined the relationship between caregivers’ acceptance of the test, treat and refer practice and the diagnosis and treatment aspects that the child had received from the CP/PPMV (mRDT test and ACT prescription). We present the results of bivariate analysis of survey data on the acceptability of malaria test, treatment and referral practices (Table 3 ). Acceptability was greater among caregivers of children aged 13 months and older than among caregivers of children aged 0–12 months (93% vs. 76%, p = 0.004). There was a statistically significant relationship between high acceptability and whether a child was tested and prescribed ACT. Caregivers of children prescribed ACT had greater acceptance than did those not prescribed ACT (92% vs. 69%, p = 0.010) (Table 3 ). Table 3 Factors associated with acceptability of the test, treatment, and referral. Low acceptability High acceptability p value Sex of sick child 0.89 Male 11.0 89.0 Female 10.3 89.7 Age of sick child (in months) 0.00 0–12 months 24.2 75.8 13 months or more 6.8 93.2 Age of caregiver 0.02 18–24 33.3 66.7 25 and above 9.2 90.8 Marital Status 0.40 Not married 18.2 81.8 Married 10.1 89.9 Highest level of education achieved 0.40 Primary school or less 10.5 89.5 Secondary 14.5 85.5 2 + years postsecondary 7.2 92.8 Employment status 0.60 Unemployed 13.3 86.7 Employed 10.0 90.0 Wealth Index 0.35 Lowest 14.0 86.0 Middle 6.3 93.7 Highest 13.5 86.5 State 0.60 Kaduna 9.3 90.7 Lagos 12.0 88.0 Time of presentation to CP/PPMV after the onset of symptoms 0.00 7 days or more 36.4 63.6 Less than 7 days 8.6 91.4 mRDT Testing 0.00 Not tested 22.9 77.1 Tested 4.9 95.1 ACT prescription by CP/PPMV 0.01 ACT not prescribed 31.3 68.7 ACT prescribed 8.3 91.7 Test result 0.00 Not tested 22.9 77.1 mRDT negative 11.1 88.9 mRDT positive 4.3 95.7 PERCEPTION AND ACCEPTABILITY Would visit the same CP/PPMV, next time child is sick 0.00 Yes 8.9 91.1 No 75.0 25.0 Will recommend CP/PPMV to a friend seeking treatment 0.00 Yes 9.5 90.5 No 100.0 0.0 How enthusiastic are you about the availability of a test for malaria at the CP/PPMV? 0.03 Not enthusiastic 8.5 91.5 Enthusiastic 25.0 75.0 Attitude toward testing Receiving a malaria test from the CP/PPMV store reduced the burden of telling the CP/PPMV about my child's symptoms 0.02 Disagree 22.6 77.4 Agree 7.6 92.4 A malaria test result provides an objective assessment of what was wrong with my child 0.02 Disagree 26.3 73.7 Agree 8.4 91.6 It was beneficial that my child was tested for malaria at the CP/PPMV shop 0.00 Disagree 26.5 73.5 Agree 6.0 94.0 Table 4 presents a multivariable adjusted analysis of the factors associated with the acceptability of the test, treatment, and referral practices for malaria. Acceptability of the test, treat, and refer practice was significantly associated with older children (more than 12 months old) [OR 4.36; 95% confidence interval (CI) 1.49, 12.74; p = 0.007] and older caregivers (25 years and above) [OR 4.92; CI 4.6–94.3; p = 0.037]. Additionally, acceptability was also high when children were tested using mRDT [OR 5.77; CI 1.88, 17.73; p = 0.002] and CPs/PPMVs prescribed ACT [OR 5.00; CI 1.47, 17.00; p = 0.010]. After controlling for other factors in the adjusted analysis, the associations between acceptability and mRDT test, ACT prescription, age of sick child, and age of caregiver remained the same (Table 4 ). Table 4 Factors associated with the acceptability of the test, treatment, and referral practices for malaria. Variables Unadjusted odds Ratio (95% CI) p value Adjusted odds ratio (95% CI) p value Sex of sick child Male 1 1 Female 1.07 (0.38, 3.05) 0.893 1.45 (0.33, 6.28) 0.619 Age of sick child 12 months or less 1 1 More than 12 months 4.36 (1.49, 12.74) 0.007 7.72 (1.61, 37.10) 0.011 Age of caregiver 18–24 years 1 25 years and above 4.92 (1.10, 22.04) 0.037 21.66 (1.42, 330.60) 0.027 Highest level of education attained Primary school or less 1 1 Secondary 0.69 (0.14, 3.52) 0.658 3.44 (0.29, 41.08) 0.329 2 + years postsecondary 1.50 (0.27, 8.45) 0.642 3.52 (0.28, 44.48) 0.330 Employment status Unemployed 1 1 Employed 1.38 (0.41, 4.64) 0.598 1.87 (0.27, 13.10) 0.526 Wealth index Low 1 1 Medium 2.40 (0.66, 8.72) 0.183 4.03 (0.60, 27.23) 0.153 High 1.04 (0.30, 3.58) 0.948 0.71 (0.10, 4.96) 0.728 State Kaduna 1 Lagos 0.75 (0.26, 2.14) 0.598 0.15 (0.02, 1.19) 0.074 mRDT Testing Not tested 1 1 Tested 5.77 (1.88, 17.73) 0.002 6.12 (1.38, 27.09) 0.017 ACT administered by CP/PPMV Not administered 1 1 Administered 5.00 (1.47, 17.00) 0.010 23.84 (3.44, 165.00) 0.001 Discussion The primary objective of this study was to assess the acceptability of the test, treatment, and referral practices for malaria management provided by CPs/PPMVs from the perspective of their clients and caregivers of children under five years of age. The research also explored the factors associated with this acceptability. This study examined three essential components of malaria management practice: testing, treating, and referring as implemented by private sector actors (CP/PPMV) at the community level. This study is one of the limited studies that specifically explored the acceptability of malaria management services, encompassing all three key aspects: testing, treating, and referring. Unlike recent studies that have focused primarily on the acceptability of services provided by community health workers, our study specifically targeted community private sector operators (CPs and PPMVs) as the service providers under consideration. The results of this study indicate that the test, treat, and refer practice received positive feedback from caregivers, as evidenced by a high level of acceptance. It is worth noting that, while the number of children referred was not substantial enough to draw definite conclusions about the association, 86% (6/7) of caregivers followed through and took their children to the referral facilities as recommended. This finding suggested a favorable response to the referral component of malaria management services. Our research findings align with the results reported by a previous study conducted in Uganda ( 24 ). Like this study, we found that conducting malaria testing using mRDT and prescribing appropriate medications, such as ACT, significantly influenced caregivers' acceptance of the malaria management services they received. These determinants play a crucial role in shaping caregivers' perceptions of the services provided. Furthermore, the study revealed that acceptability was high for children older than one year. Additionally, there was compelling evidence indicating that caregivers aged 25 years and above were more inclined to find the services provided by CP/PPMV acceptable than their younger counterparts who sought care from the same sources. The disparity in acceptability based on the age of the caregivers might imply that older caregivers rely on their experience and personal judgment when assessing the adequacy of care provided by CP/PPMV. In contrast to the findings of the present study, earlier research conducted in Ghana revealed that the marital status of caregivers had a significant influence on the acceptance of RDT-based management of malaria ( 38 ). However, in our present study, we did not observe a significant relationship between caregiver marital status and the acceptability of the test, treat, and refer approach for malaria management. This disparity in findings could be due to differences in context or population. The study also highlights the importance of considering diverse factors that can influence acceptability when designing and implementing malaria management strategies in different regions. The findings of this study hold significant implications for multiple reasons. First, the adoption of the test, treat, and refer practice as a standard approach by CPs and PPMVs could replace the customary practice of prescribing medications without conducting tests. This shift has the potential to improve the quality of malaria management services and enhance patient outcomes. Second, clients seeking malaria management services can have higher expectations and acceptance if they are regularly offered the test, treat, or refer practice by private sector providers. This may foster greater trust and confidence in the services provided by CPs and PPMVs, leading to increased utilization and adherence to treatment recommendations. Third, the study revealed that a proportion of individuals received ACT treatment without undergoing testing, indicating a need for further interventions and training to improve the adherence of CPs and PPMVs to recommended guidelines. Similarly, the data suggest that CPs/PPMVs do not refer children with fever lasting more than seven days as per national guidelines (data not shown), signaling the necessity for targeted efforts to address this gap in adherence. Finally, these research outcomes provide valuable insights for addressing the existing gaps in the services offered by CPs and PPMVs. By identifying areas of improvement and emphasizing the implementation of standardized practices, policymakers and healthcare authorities can work toward enhancing the overall quality of malaria management services provided by private sector operators. Limitations This study is not without its limitations, which we need to consider when interpreting the results. First, there might be recall issues, as caregivers were required to remember events that occurred at least two weeks prior to the interviews. Memory accuracy over such a period could lead to potential biases in the data. Second, the study focused solely on female caregivers responsible for children under the age of five. This restricted scope may limit the generalizability of the findings to other populations. Another limitation was the nonrandom sampling method used to select participants. The convenience sampling approach, which involved specifically targeting caregivers who visited trained CPs and PPMVs who received IntegratE's intervention package, might introduce selection bias. Consequently, the findings may not be fully representative of all caregivers seeking services from private sector operators. Moreover, the absence of a comparison group, consisting of clients who visited untrained CPs and PPMVs, hinders the ability to assess the impact of the intervention accurately. It is essential to acknowledge these limitations to better contextualize and interpret the study's results. Conclusion The findings of this study demonstrated that caregivers of febrile children find the test, treatment, and referral practices for malaria management to be acceptable. However, these findings also highlight a concerning issue where not all sick children were subjected to mRDT testing before receiving treatment. This indicates the need for further efforts to ensure that CPs and PPMVs adhere to standardized malaria management procedures. To improve this situation, there is a crucial necessity to raise awareness among caregivers about the importance of expecting the full spectrum of care when seeking services from trained providers such as CPs and PPMVs. Creating awareness can empower caregivers to advocate for proper testing and appropriate treatment for their children. Moreover, continued supportive supervision and monitoring should be used to ensure that CPs and PPMVs consistently follow the national guidelines for malaria management. This ongoing oversight will help reinforce adherence to established protocols and maintain the quality of care provided by these private sector operators. Overall, this study emphasizes the significant role played by CPs and PPMVs in delivering malaria management services and highlights the continuous improvement needed to optimize their contributions to public health. By addressing these challenges and implementing effective strategies, we can enhance the effectiveness and quality of malaria management in the community setting, ultimately benefiting the health and well-being of affected children and their caregivers. Abbreviations ACT: Artemisinin-based combination therapy; CPs: Community Pharmacists; CIs: Confidence intervals; FP: Family Planning; ICCM: Integrated Community Case Management; IRB: Institutional Review Board; mRDT: Malaria Rapid Diagnostic Tests; NHREC: National Health Research Ethics Committee; NMEP: National Malaria Elimination Program; OR: Odds Ratio; PCN: Pharmacy Council of Nigeria; PPMVs: Patent and Proprietary Medicine Vendors; RME: Research, Monitoring and Evaluation; SSA: Sub-Saharan Africa. Declarations Ethics approval and consent to participate : We received ethical approval from the Population Council's Institutional Review Board and the National Health Research Ethics Committee (NHREC) of the Federal Ministry of Health. All participants provided verbal informed consent after we informed them about the objective of the study during the phone interview. Consent for publication : Not applicable. Availability of data and materials : The deidentified dataset analyzed during the current study will be available on the Population Council’s Dataverse, https://dataverse.harvard.edu/dataverse/popcouncil. The data will also be available from the corresponding author upon reasonable request. Competing interests : The authors declare no competing interests. Funding : The research in this publication was supported by funding from The Bill & Melinda Gates Foundation [INV-007278, formerly OPP1173898]. The opinions and inferences made in this work are those of the authors and not the funding agencies. Authors' contributions : The paper was conceived and designed by TOA and SB. The data collection was supervised by SB, TOA, TA, OU, and OM. Statistical analysis, tables and chart were prepared by TOA, and the findings were interpreted by TOA and SB. TOA prepared the first draft of the manuscript; TA drafted the Background section; OU drafted the Methods section; and EEO, SB, EDE, OU, OM, TA, TOA and RD made substantive revisions to subsequent drafts. All the authors read and approved the submitted version. Acknowledgments : This study was conducted in collaboration with the Federal Ministry of Health of Nigeria, Pharmacists Council of Nigeria, National Association of Patent and Proprietary Medicine Dealers, State Ministries of Health in Kaduna, and Lagos and the IntegratE consortium partners. We thank Dele Abegunde for his guidance during the writing of the manuscript. We appreciate the dedication and efforts of the research team and data collectors. Furthermore, we acknowledge all the caregivers who provided valuable information for this study. References World Health Organization (WHO). Guidelines for the treatment of malaria. 3rd ed. Geneva: World Health Organization. ; 2015. Available from: https://apps.who.int/iris/handle/10665/162441 . WHO. World malaria report 2019. Geneva: World Health Organization. ; 2019. Available from: https://apps.who.int/iris/handle/10665/330011 . Artavanis-Tsakonas K, Tongren JE, Riley EM. The war between the malaria parasite and the immune system: immunity, immunoregulation and immunopathology. Clin Exp Immunol. 2003;133(2):145–52. 10.1046/j.1365-2249.2003.02174.x . Kitua AY, Smith T, Alonso PL, Masanja H, Urassa H, Menendez C, Kimario J, Tanner M. Plasmodium falciparum malaria in the first year of life in an area of intense and perennial transmission. Tropical Medicine & International Health. 1996;1(4):475–484. 10.1046/j.1365-3156 . 1996.d01-89.x. Doolan DL, Dobaño C, Baird JK. Acquired immunity to malaria. Clin Microbiol Rev. 2009;22(1):13–36. doi/10.1128/CMR.00025 – 08. Uhomoibhi P, Okoronkwo C, Ajayi IO, Mokuolu O, Maikore I, Fagbamigbe A, et al. Drivers of long-lasting insecticide-treated net utilisation and parasitaemia among under-five children in 13 States with high malaria burden in Nigeria. PLoS ONE. 2022;17(5):e0268185. https://dx.plos.org/10.1371/journal.pone.0268185 . Mann DM, Swahn MH, McCool S. Undernutrition and malaria among under-five children: findings from the 2018 Nigeria demographic and health survey. Pathogens Global Health. 2021;115(6):423–33. doi/full/10.1080/20477724.2021.1916729 . Bah MS. The relationship between malaria status in under-five children and some household demographic, socioeconomic and environmental factors associated with the disease in Sierra Leone. Ga State Univ Public Health Theses. 2020. doi.org/10.57709/17625877 . Gahutu JB, Steininger C, Shyirambere C, Zeile I, Cwinya-Ay N, Danquah I, et al. Prevalence and risk factors of malaria among children in southern highland Rwanda. Malar J. 2011;10(1):134. https://doi.org/10.1186/1475-2875-10-134 . Kweku M, Takramah W, Axame WK, Owusu R, Takase M, Adjuik M, et al. Prevalence and risk factors of malaria among children under five years in High and Low altitude rural communities in the Hohoe Municipality of Ghana. J Clin Immunol Res. 2017;1:1–8. http://dx.doi.org/10.33425/2639-8494.1003 . Marsh K, Forster D, Waruiru C, Mwangi I, Winstanley M, Marsh V et al. Indicators of life-threatening malaria in African Children. The New England Journal of Medicine. 1995;332(21):1399–404. 7. 10.1056/NEJM199505253322102 . Mishra SK, Newton CR. Diagnosis, and management of the neurological complications of falciparum malaria. Nat Rev Neurol. 2009;5(4):189–98. 10.1038/nrneurol.2009.23 . Holding PA, Kitsao-Wekulo PK. Describing the burden of malaria on child development: what should we be measuring and how should we be measuring it? Am J Trop Med Hyg. 2004;71(2suppl):71–9. 10.4269/ajtmh.2004.71.2_suppl.0700071 . WHO. Universal access to malaria diagnostic testing: an operational manual. Geneva: World Health Organization; 2011. https://apps.who.int/iris/handle/10665/44657 . National Malaria Control Programme [NMCP]. National Guidelines for Diagnosis and Treatment of Malaria. Abuja, Nigeria: NMCP, Federal Ministry of Health; 2011. Beargie SM, Higgins CR, Evans DR, Laing SK, Erim D, Ozawa S. The economic impact of substandard and falsified antimalarial medications in Nigeria. Carvalho LH, editor. PLoS ONE. 2019;14(8): e0217910. 10.1371/journal.pone.0217910 . World Health Organization. World Malaria Report 2013 Geneva. WHO; 2013. https://apps.who.int/iris/handle/10665/97008 . Lubell Y, Reyburn H, Mbakilwa H, Mwangi R, Chonya S, Whitty CJM, et al. The impact of response to the results of diagnostic tests for malaria: cost-benefit analysis. BMJ. 2008;336(7637):202–5. doi/10.1136/bmj.39395.696065.47 . Bisoffi Z, Ende JVD. Costs of treating malaria according to test results. BMJ. 2008;336(7637):168–9. doi/10.1136/bmj.39401.486655.80 . English M, Reyburn H, Goodman C, Snow RW. Abandoning presumptive antimalarial treatment for febrile children aged less than five years—A case of running before we can walk? PLoS Med. 2009;6(1):e1000015. .dx.plos.org/10.1371/journal.pmed.1000015 . Williams HA, Causer L, Metta E, Malila A, O’Reilly T, Abdulla S, et al. Dispensary level pilot implementation of rapid diagnostic tests: an evaluation of RDT acceptance and usage by providers and patients – Tanzania, 2005. Malar J. 2008;7(1):239. doi.org/10.1186/1475-2875-7-239 . Kyabayinze DJ, Asiimwe C, Nakanjako D, Nabakooza J, Counihan H, Tibenderana JK. Use of RDTs to improve malaria diagnosis and fever case management at primary health care facilities in Uganda. Malar J. 2010;9(1):200. doi.org/10.1186/1475-2875-9-200 . Mukanga D, Tibenderana JK, Peterson S, Pariyo GW, Kiguli J, Waiswa P, Babirye R, Ojiambo G, Kasasa S, Pagnoni F, Kallander K. Access, acceptability, and utilization of community health workers using diagnostics for case management of fever in Ugandan children: a cross-sectional study. Malar J. 2012;11(1):121. 10.1186/1475-2875-11-121 . Tabuti JR. Herbal medicines used in the treatment of malaria in Budiope county. Uganda J Ethnopharmacol. 2008;116(1):33–42. 10.1016/j.jep.2007.10.036 . Uzochukwu BSC, Onwujekwe OE, Okwuosa C, Ibe OP. Patent medicine dealers and irrational use of medicines in children: the economic cost and implications for reducing childhood mortality in southeast Nigeria. PLoS ONE. 2014;9(3):e91667. doi.org/10.1371/journal.pone.0091667 . Isiguzo C, Anyanti J, Ujuju C, Nwokolo E, De La Cruz A, Schatzkin E, et al. Presumptive treatment of malaria from formal and informal drug vendors in Nigeria. PLoS ONE. 2014;9(10):e110361. doi.org/10.1371/journal.pone.0110361 . Treleaven E, Liu J, Prach LM, Isiguzo C. Management of paediatric illnesses by patent and proprietary medicine vendors in Nigeria. Malar J. 2015;14(1):232. doi.org/10.1186/s12936-015-0747-7 . Mushi AK, Massaga JJ, Mandara CI, Mubyazi GM, Francis F, Kamugisha M, et al. Acceptability of malaria rapid diagnostic tests administered by village health workers in Pangani District, Northeastern Tanzania. Malar J. 2016;15(1):439. doi.org/10.1186/s12936-016-1495-z . Liu J, Prach LM, Treleaven E, Hansen M, Anyanti J, Jagha T, et al. The role of drug vendors in improving basic health-care services in Nigeria. Bull World Health Organ. 2016;94(4):267–75. 10.2471/BLT.15.154666 . National Population Commission (NPC). [Nigeria] and ICF. Nigeria Demographic and Health Survey 2018. Abuja, Nigeria, and Rockville. Maryland, USA: NPC and ICF; 2019. Akuiyibo SM, Anyanti J, Amoo BA, Aizobu D, Idogho O. Common childhood illnesses: a cross-sectional study of commodity stocking patterns and management knowledge among patent and proprietary medicine vendors in Nigeria. Archives Public Health. 2022;80(1):88. 10.1186/s13690-022-00846-x . Shayo EH, Rumisha SF, Mlozi MRS, Bwana VM, Mayala BK, Malima RC, et al. social determinants of malaria and health care seeking patterns among rice farming and pastoral communities in Kilosa District in central Tanzania. Acta Trop. 2015;144:41–9. 10.1016/j.actatropica.2015.01.003 . Mayala BK, Fahey CA, Wei D, Zinga MM, Bwana VM, Mlacha T, et al. Knowledge, perception and practices about malaria, climate change, livelihoods, and food security among rural communities of central Tanzania. Infect Dis Poverty. 2015;4(1):21. 10.1186/s40249-015-0052-2 . Omondi CJ, Odongo D, Otambo WO, Ochwedo KO, Otieno A, Lee MC, et al. Malaria diagnosis in rural healthcare facilities and treatment-seeking behavior in malaria endemic settings in western Kenya. PLOS Global Public Health. 2023;3(7):e0001532. 10.1371/journal.pgph.0001532 . Drakeley C, Reyburn H. Out with the old, in with the new: the utility of rapid diagnostic tests for malaria diagnosis in Africa. Trans R Soc Trop Med Hyg. 2009;103(4):333–7. doi/10.1016/j.trstmh.2008.10.003 . Oko AB, Jennifer A, Chinyere AJ, Nelson NJ, Omokhudu I, Edward OC, et al. Assessment of integrated community case management of childhood illness (ICCM) practices by trained patent and proprietary medicine vendors (PPMVs) in Ebonyi and Kaduna states, Nigeria. BMC Health Serv Res. 2023;23(1):57. 10.1186/s12913-023-09067-6 . Baiden F, Owusu-Agyei S, Okyere E, Tivura M, Adjei G, Chandramohan D, et al. Acceptability of rapid diagnostic test-based management of malaria among caregivers of under-five children in rural Ghana. PLoS ONE. 2012;7(9):e45556. 10.1371/journal.pone.0045556 . Ansah EK, Narh-Bana S, Affran-Bonful H, Bart-Plange C, Cundill B, Gyapong M, et al. The impact of providing rapid diagnostic malaria tests on fever management in the private retail sector in Ghana: a cluster randomized trial. BMJ. 2015;350:h1019–9. doi.org/10.1136/bmj.h1019 . Hansen KS, Pedrazzoli D, Mbonye A, Clarke S, Cundill B, Magnussen P, et al. Willingness-to-pay for a rapid malaria diagnostic test and artemisinin-based combination therapy from private drug shops in Mukono district, Uganda. Health Policy Plann. 2013;28(2):185–96. doi/10.1093/heapol/czs048 . Dozie UW, Ebirim CIC, Nwobi UO, Chukwuocha UM, Ibe SNO, Dozie INS. Sociodemographic Factors Influencing the Uptake of Rapid Diagnostic Test Kits for the Management of Malaria among Mothers of Under Five in a Typical Nigerian Population. Annals Community Health. 2021. (ISSN 2347–5455, eISSN 2347–5714). Lawal AM, Balogun SK, Bada BV. Knowledge of transmission, malaria belief and health-seeking behaviour in Oye-Ekiti local government area of Ekiti state, Nigeria. Am J Rural Dev. 2014;2(1):8–12. 10.12691/ajrd-2-1-2 . Chukwuocha UM, Okpanma AC, Nwakwuo GC, Dozie INS. Determinants of delay in seeking malaria treatment for children under-five years in parts of Southeastern Nigeria. J Community Health. 2014;39(6):1171–8. 10.1007/s10900-014-9872-4 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 09 Oct, 2024 Read the published version in Malaria Journal → Version 1 posted Editorial decision: Revision requested 10 May, 2024 Reviews received at journal 22 Feb, 2024 Reviewers agreed at journal 12 Feb, 2024 Reviewers invited by journal 12 Feb, 2024 Submission checks completed at journal 07 Feb, 2024 Editor assigned by journal 07 Feb, 2024 First submitted to journal 07 Feb, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Akomolafe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYFACNhBhwcDewHwALnbgAR4NPBAtEgw8B9gSEFoScChH08JjgBDGp8We/VjioxsVEvI87D3fHnzcYSdncLv5IdAWm3x5Bxy28KQdNs45I2HYw3N2u+HMM8nGBneOGQC1pFluPIBDC0N6m3RumwTjfoncbdK8bQcSN9zIAfnlsIFhAw4t/M/BWux75N88I1KLRNoxkJbEHgkeNlQt8ji8z3PjWTLIL8k9PGnmYL9I3kgD+sUgzcAAhxb2/jTDxzkVNrY97IefgUOM70by4w8fKmwM5HE4DBmwMTDCVQGtMDhAmhYgIMaWUTAKRsEoGBEAADTmXJ5Oc40vAAAAAElFTkSuQmCC","orcid":"","institution":"Population Council","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Toyin","middleName":"O.","lastName":"Akomolafe","suffix":""},{"id":271761124,"identity":"2fa662b2-ad14-4672-bdae-d9eebacedd4d","order_by":1,"name":"Sikiru Baruwa","email":"","orcid":"","institution":"Population Council","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sikiru","middleName":"","lastName":"Baruwa","suffix":""},{"id":271761125,"identity":"f1faf305-0b20-4671-85ca-72f106b6eb99","order_by":2,"name":"Emeka Emmanuel Okafor","email":"","orcid":"","institution":"Population Council","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Emeka","middleName":"Emmanuel","lastName":"Okafor","suffix":""},{"id":271761126,"identity":"3f416605-1c13-4758-8903-1d820b66d38f","order_by":3,"name":"Ene Daniel-Ebune","email":"","orcid":"","institution":"Pharmacy Council of Nigeria (PCN)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ene","middleName":"","lastName":"Daniel-Ebune","suffix":""},{"id":271761127,"identity":"4796d341-a51d-4c48-889c-482e9c86ce0f","order_by":4,"name":"Theophilus Ajibade","email":"","orcid":"","institution":"Population Council","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Theophilus","middleName":"","lastName":"Ajibade","suffix":""},{"id":271761128,"identity":"01722a9c-0887-45ce-aacf-c86758d36cc5","order_by":5,"name":"Osimhen Ubuane","email":"","orcid":"","institution":"Population Council","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Osimhen","middleName":"","lastName":"Ubuane","suffix":""},{"id":271761129,"identity":"c80db49e-9605-446d-9fcb-313a2c11fbfe","order_by":6,"name":"Oluwatobi Morakinyo","email":"","orcid":"","institution":"Population Council","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Oluwatobi","middleName":"","lastName":"Morakinyo","suffix":""},{"id":271761130,"identity":"21b8ce88-4855-43b8-94d3-8f4599106c11","order_by":7,"name":"Rodio Diallo","email":"","orcid":"","institution":"Bill \u0026 Melinda Gates Foundation","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rodio","middleName":"","lastName":"Diallo","suffix":""}],"badges":[],"createdAt":"2024-02-07 15:14:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3937247/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3937247/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12936-024-05114-7","type":"published","date":"2024-10-09T15:57:07+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":66597327,"identity":"5b0a868e-25ba-48f2-bc6f-98db78b24f0f","added_by":"auto","created_at":"2024-10-14 16:09:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1336753,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3937247/v1/7d5acd24-06ce-49f4-a783-65dcb99e7fe0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors Influencing the Acceptability of the Test, Treat and Refer Practice for Malaria among Caregivers of Under 5 Children at Community Pharmacies and Drug Shops in Nigeria","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn 2010, the World Health Organization revised protocols for malaria treatment guidelines that recommended screening for malaria infection before treatment (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Because the use of microscopy is limited in most healthcare facilities in Sub-Saharan Africa (SSA), rapid diagnostic tests (RDTs) are recommended for test-based management of malaria (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The burden of malaria affects children under the age of five and pregnant women, leading to high morbidity and mortality rates (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Approximately, 67% (272,000) of global malaria deaths were among children under five years of age (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). A major explanation for this difference was that infants and young children under five years of age are at high risk of clinical episodes from their low or no protective immune mechanism against malaria infection (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Most studies have shown that children under two years of age (\u003cspan additionalcitationids=\"CR7 CR8 CR9 CR10\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e11\u003c/span\u003e) are at increased risk of malaria infection. Among under five children, the negative consequences of malaria manifest in the form of chronic anemia, low birth weight, reduced growth, and other cases of severe intellectual disabilities (\u003cspan additionalcitationids=\"CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobally, Nigeria has the highest number of malaria cases and deaths, accounting for approximately 27% of all malaria cases and 23% of all malaria deaths (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). According to the 2019 World Malaria Report, Nigeria reported an estimated 25% increase in malaria cases between 2015 and 2019 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The WHO introduced the use of malaria Rapid Diagnostic Tests (mRDT) kits to increase the accuracy and improve confidence in malaria diagnosis, and this approach has been reported to reduce misdiagnosis and management of malaria cases (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In Nigeria, the National Malaria Elimination Program (NMEP) has prioritized the deployment of mRDTs as a cost-effective method for diagnosing malaria at primary healthcare facilities (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e16\u003c/span\u003e). This strategy allows for quick and reliable diagnosis without requiring specialized laboratory equipment or trained personnel. Collaborations with international organizations and donor agencies have ensured the availability and distribution of RDTs across the country (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEffective treatment of malaria requires the use of appropriate antimalarial drugs based on accurate diagnosis and consideration of factors such as drug resistance patterns and patient characteristics (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Artemisinin-based combination therapy (ACT) is recommended as the first-line treatment for uncomplicated malaria. However, the availability and accessibility of ACT, as well as the appropriate use of antimalarial drugs, remain challenges in sub-Saharan Africa, including Nigeria (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The use of substandard or counterfeit antimalarial drugs in Nigeria has health and economic impacts, contributing to treatment failure and prolonged illness (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eImproving the diagnosis and treatment of malaria will not only improve treatment outcomes but also assist in rationalizing healthcare costs by reducing the consumption and resistance of antimalarial drugs (\u003cspan additionalcitationids=\"CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The pertinent literature has revealed that the roll-out of mRDTs in health facilities can reduce the overprescription of antimalarials (\u003cspan additionalcitationids=\"CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e23\u003c/span\u003e) and treat those with positive results in line with the appropriate treatment guidelines. However, facility-based providers are not the only source of treatment for febrile illness, or even the main source in many settings (\u003cspan additionalcitationids=\"CR25 CR26 CR27 CR28\" citationid=\"CR23\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral studies have highlighted the potential benefits of engaging patent and proprietary medicine vendors (PPMVs), who are operators of drug shops in the fight against malaria, as well as increased access to clients (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In sub-Saharan Africa, PPMVs have been identified as key players in the provision of malaria treatment due to their accessibility and availability in communities. Studies conducted in Nigeria have shown that compared with public health facilities, PPMVs are the preferred source of malaria treatment for many people due to their proximity and longer operating hours and that they play a critical role in the provision of ACTs for malaria treatment (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e32\u003c/span\u003e). A study conducted in Tanzania revealed that PPMVs were the most common health facility providers visited for fever-related illnesses, including malaria, in rural areas (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Similarly, a study in Kenya showed that PPMVs were the most commonly used healthcare providers for malaria treatment, especially in rural areas with limited access to healthcare facilities (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn many countries in sub-Saharan Africa, formal and informal health systems including the communities, are now using RDTs to guide malaria treatment decisions in routine care (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e36\u003c/span\u003e). In Nigeria, to reduce misdiagnosis and treatment of malaria in the informal sector, the government permitted Community Pharmacists (CPs) and PPMVs to administer RDTs as part of new guidelines for integrated management of childhood illnesses and malaria (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Some studies have documented the acceptability of deploying RDTs to confirm the diagnosis of malaria in community settings among community health workers (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e38\u003c/span\u003e), but very little evidence is available on the varying factors that influence the acceptability of malaria testing among caregivers of children under five years of age, especially among CPs and PPMVs who are for profit-making (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e40\u003c/span\u003e). More evidence is needed in this regard, as we know that behavioral change, especially for health-seeking individuals, depends on a number of factors, such as individuals\u0026rsquo; perceptions of health benefits, the characteristics of the individuals who may adopt the change, and contextual factors within the community (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Understanding these factors and their influence on health-seeking behavior from the caregivers\u0026rsquo; point of view is critical and relevant to understanding the receptibility of RDTs for diagnosing malaria before treating children younger than five years in the hands of CPs and PPMVs. The aim of this study was therefore to explore the factors likely to influence caregivers\u0026rsquo; acceptance of the test, treatment and referral practices by CPs and PPMVs within the context of community case management of fever in children under five years of age in Nigeria.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eIntervention\u003c/h2\u003e \u003cp\u003eIntegratE 2.0 has the goal of improving the retail private sector's delivery of family planning (FP) and a selection of primary healthcare (PHC) services through standardized training. These PHC services include the management of malaria, pneumonia, diarrhea, nutritional status, and tuberculosis. Supported by the Bill \u0026amp; Melinda Gates Foundation, the project collaborates with the Pharmacy Council of Nigeria (PCN) and other stakeholders to pilot, integrate, and increase the provision and access to quality FP and PHC services by CPs and PPMVs across 11 Nigerian states. The project adopted a tiered accreditation system in which PCN categorized PPMVs into three tiers based on their education and health qualifications. This categorization also determines the type of FP training received and the services provided. Those without health-related qualifications were categorized as Tier 1, those with educational backgrounds that the PCN deemed to be health-related (e.g., Nursing and Midwifery, or Community Health Extension) were categorized as Tier 2, and those with pharmacy technician certificates were categorized as Tier 3. Under the pilot 3-tier accreditation system, Tier 1 PPMVs participated in 12-day training at PCN-accredited schools of health technology; and topics in PHC services (malaria, diarrhea, pneumonia); in FP counseling; in the provision of condoms, cycle beads and oral contraceptive refills; in referrals for FP methods; and in documenting FP services were covered. Tier 2 and Tier 3 PPMVs received the same training as Tier 1 PPMVs plus an additional 3 days of training on injectable administration and implant insertion and removal. PCN staggered training days for 4 and 5 weeks for tier 1 PPMVs and tier 2 and 3 PPMVs, respectively. PCN organized a training of trainers (ToT) for accredited schools of health technology on the 3-tier accreditation approach. On the other hand, CPs have a pharmacy degree, and PCN register and license them. Therefore, they function outside of the pilot accreditation system but receive the same training as Tier 2 and Tier 3 PPMVs.\u003c/p\u003e \u003cp\u003eBetween January and September 2022, as part of Integrated Community Case Management (ICCM) training, CPs and PPMVs received training in malaria case management, including how to recognize common symptoms in children, perform the malaria Rapid Diagnostic Test (mRDT) accurately, administer appropriate treatment using Artemisinin-based Combination Therapy (ACT) after a positive mRDT result and identify severe signs and symptoms of other febrile illnesses that should be referred to the nearest health facility for further investigation and management.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStudy sites.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe implementation of the IntegratE project commenced in Lagos and Kaduna states in 2018. The project trained CPs and PPMVs on malaria case management in 2022. Lagos State, with a population of 9,013,534, is in the southwestern part of Nigeria (44), while Kaduna State, with a population of 6,113,503, is in the northern part of the country (44). According to the 2018 Nigeria Demographic and Health Survey, the prevalence of malaria in children is lower in Lagos State (3.4%) than in Kaduna State (34.3%) (44). We conducted exit interviews among caregivers of under five children after providers had settled into their new role of providing malaria services in line with the national malaria treatment guidelines. The malaria treatment guidelines in Nigeria recommend screening individuals who have a history of fever in the past 48 hours with an mRDT kit or microscopy, followed by treatment with artemisinin-based combination therapy if the test results are positive.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Sampling\u003c/h2\u003e \u003cp\u003e We conducted a cross-sectional quantitative telephone survey among caregivers of children under-five years of age who received malaria services from IntegratE-trained CPs and PPMVs to determine their acceptance of the WHO \u0026ldquo;test, treat and refer\u0026rdquo; practices for malaria in Kaduna and Lagos states. Using the study tool, we interviewed a total of 150 caregivers of children under five years old who received malaria services from CPs and PPMVs in the two states: seventy-five in Lagos and seventy-five in Kaduna. CPs and PPMVs informed their clients about the study and requested their permission to share their details, including phone numbers, with the IntegratE Research, Monitoring, and Evaluation (RME) team.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eTo facilitate this research, we trained four interviewers in research ethics, study design and objectives, procedures for administering informed consent forms, and telephone interview techniques. We interviewed caregivers of under 5 children who received malaria treatment from CPs and PPMVs from May to July 2022 to gather evidence on the process and perception of treatment received from these providers, adherence to treatment guidelines and referral of clients to health facilities when appropriate. The interviewers called caregivers who agreed to share their information with the research team to confirm their eligibility. Eligible respondents were caregivers of under 5 children who received malaria services from a trained CP or PPMV and owned a cell phone. If eligible, trained data collectors provided potential respondents with details of the study, including the objectives, what we expected of them as respondents, and potential risks and benefits of participation. They interviewed those who agreed over the phone and compensated them with 1000 Naira (approximately 1.39 USD) in phone credit. The interviewers used tablets to administer a quantitative interview that included questions on sociodemographic characteristics; perception and acceptability of the malaria test; treatment and referral from the CP or PPMV; and general experiences receiving malaria services from the CP or PPMV. The interviewers recorded their responses on tablets using the Kobo toolbox app to facilitate timely submission and analysis of the data. The results were explored by examining relevant characteristics such as provider type, state, age, marital status, and parity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eDependent variable\u003c/h2\u003e \u003cp\u003eWe measured the dependent variable, acceptability of the services received from CPs and PPMVs using their level of satisfaction. Using a Likert scale, we asked caregivers if they were: very satisfied, satisfied, somewhat satisfied, somewhat unsatisfied or not satisfied at all with the services received from the CP/PPMV. Responses were dichotomized as high satisfaction (very satisfied and satisfied) or low satisfaction (somewhat satisfied, somewhat unsatisfied, not satisfied at all) for the analysis.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eIndependent variables\u003c/h2\u003e \u003cp\u003eThe demographic characteristics of the caregivers included age, marital status, education level, employment status, and the household wealth index. We included the age and sex of the sick child in the demographic data. We grouped the ages of the caregivers into three categories: 15\u0026ndash;24 years, 25\u0026ndash;34 years, and 35 years and older. We categorized marital status into two categories: not married and married. We grouped the education level of the caregivers into four categories: primary school or less, secondary, and two plus years postsecondary. We categorized employment status as unemployed or employed. The household wealth index was measured using a composite score calculated using principal component analysis of household asset items and then categorized into the lowest, middle, and highest scores. We grouped the ages of the sick children into two groups: 0\u0026ndash;12 months and 13 months and older. Other independent variables included the time of presentation to the CP/PPMV, testing using mRDT, test results, ACT prescription, and 5 attitudinal questions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eWe exported the data into Stata version 16.1 for analysis. The results were explored by examining relevant characteristics such as provider type, state, age, marital status, and parity. Descriptive analysis of demographic characteristics and the use of malaria testing, treatment using ACT and referral services was performed using frequencies. Bivariate analysis was also conducted to identify factors significantly associated with acceptance of malaria management services. Associations between factors and acceptability were tested using the chi-square (χ2) test. The 95% level was used to define statistically significant associations (p\u0026thinsp;\u0026le;\u0026thinsp;0.05) for further consideration. All statistically significant factors from the bivariate analysis were explored using logistic regression models and odds ratios (ORs) with confidence intervals (CIs) were calculated to predict acceptability. Variables associated with acceptability according to bivariate analysis, such as malaria treatment practices (testing, prescription of ACT) were included in a logistic regression model to adjust for confounding variables.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics Approval\u003c/strong\u003e \u003cp\u003e The study was approved by the Institutional Review Board (IRB) of the Population Council (Protocol 878) and the National Health Research Ethics Committee (NHREC) of the Federal Ministry of Health. Informed consent was obtained from all clients in line with relevant guidelines as approved by both ethical committees.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the demographic profile of caregivers of children under five years of age who visited CPs and PPMVs for malaria treatment. We interviewed a total of 150 female caregivers in the survey. The mean age of the caregivers was 32 years (range 18\u0026ndash;49), the majority (94%) were aged 25 years and above, and 93% of the caregivers were married or in a union. Approximately 87% had at least secondary education, 80% were employed, and 42% were in the middle-income bracket.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRespondent characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex of sick child\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge of sick child (in months)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13 months or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean age of sick child (in months)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e30.93\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge of caregiver\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;24 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25 years and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean age of caregiver (In years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e32.49\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest level of education achieved\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school or less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026thinsp;+\u0026thinsp;years postsecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmployment status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWealth Index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLowest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the results of malaria testing, treatment with ACT and referral. Most caregivers (93%) reported seeking treatment for a child within 6 days of onset of illness, and less than half (45%) sought advice or treatment the same day or next day (data not shown). All caregivers were asked questions that aided in obtaining a diagnosis of malaria. Ninety-nine percent (99%) of the caregivers were asked about signs and symptoms by CP/PPMV, 97% reported that CP/PPMV felt for fever or took the child\u0026rsquo;s temperature, and 97% of the caregivers were asked about the duration of fever. More than two-thirds of the caregivers (68%) reported that their child had blood taken from a finger or heel for testing by CP/PPMV. Of the 102 caregivers who responded to the question \u0026ldquo;What was the result of the malaria test?\u0026rdquo;, 97% reported that the child tested positive for malaria. Of the 148 caregivers who reported that CP/PPMV administered or prescribed drugs for a child, 89% reported that the child was administered artemisinin combination therapy (ACT) irrespective of whether the child tested positive or negative for malaria (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Among those who tested positive for malaria (n\u0026thinsp;=\u0026thinsp;93), 88% were administered ACT. Among caregivers whose children were administered ACT (n\u0026thinsp;=\u0026thinsp;132), 72.0% were asked to return for a follow-up visit after treatment. Only 5% of caregivers reported that the child was referred to another facility for treatment (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), and 6 out of 7 caregivers reported that the child was taken to the referral facility (data not shown).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUptake of malaria test, treatment using ACT, and referral\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime of presentation to CP/PPMV after the onset of symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7 days or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQuestions that aid in Malaria diagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCP/PPMV asked about signs and symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCP/PPMV felt for fever or took the child\u0026rsquo;s temperature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCP/PPMV asked for duration of fever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBlood taken from sick finger or heel for testing by CP/PPMV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTest result\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot tested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emRDT negative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emRDT positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eACT prescription by CP/PPMV*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACT not prescribed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACT prescribed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTested positive and treated with ACT (n\u0026thinsp;=\u0026thinsp;93)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdvised to return for follow-up visit (n\u0026thinsp;=\u0026thinsp;132)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReferred to a health facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWould visit the same CP/PPMV, next time child is sick\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWill recommend CP/PPMV to a friend seeking treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEnthusiastic about the availability of a test for malaria at the CP/PPMV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot enthusiastic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnthusiastic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAttitude toward testing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReceiving a malaria test from the CP/PPMV store reduced the burden of telling the CP/PPMV about my child's symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eA malaria test result provides an objective assessment of what was wrong with my child\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIt was beneficial that my child was tested for malaria at the CP/PPMV shop\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver chosen not to test child for malaria when they were offered the test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWill be worried if child was denied Artemisinin-based combination therapies (ACTs)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cb\u003eAcceptability and perception of the test, treat and refer practice\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eEighty-nine percent of the caregivers reported high acceptability of the services they received. Most caregivers (88%) were happy with the \u0026ldquo;form of healthcare\u0026rdquo; received, 67% with the \u0026ldquo;type of medicine\u0026rdquo; received, and 61% were happy with the use of the mRDT test. Eighty-eight percent of caregivers considered that it was important to test before treating for malaria, and 45% did not expect a blood test (mRDT) from a CP/PPMV (data not shown). Caregivers (97%) indicated that they would visit the CP/PPMV during the child\u0026rsquo;s next sick episode, and 99% would recommend the provider to friends seeking care. Only 10% of caregivers had chosen not to test a child for malaria at one time when they were offered the test. Approximately two-thirds (66%) of caregivers would be worried if provider denied the child treatment using ACT (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e We examined the relationship between caregivers\u0026rsquo; acceptance of the test, treat and refer practice and the diagnosis and treatment aspects that the child had received from the CP/PPMV (mRDT test and ACT prescription). We present the results of bivariate analysis of survey data on the acceptability of malaria test, treatment and referral practices (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Acceptability was greater among caregivers of children aged 13 months and older than among caregivers of children aged 0\u0026ndash;12 months (93% vs. 76%, p\u0026thinsp;=\u0026thinsp;0.004). There was a statistically significant relationship between high acceptability and whether a child was tested and prescribed ACT. Caregivers of children prescribed ACT had greater acceptance than did those not prescribed ACT (92% vs. 69%, p\u0026thinsp;=\u0026thinsp;0.010) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with acceptability of the test, treatment, and referral.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow acceptability\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh acceptability\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex of sick child\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge of sick child (in months)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13 months or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge of caregiver\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest level of education achieved\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school or less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026thinsp;+\u0026thinsp;years postsecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmployment status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWealth Index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLowest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eState\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKaduna\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLagos\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime of presentation to CP/PPMV after the onset of symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7 days or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003emRDT Testing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot tested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eACT prescription by CP/PPMV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACT not prescribed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACT prescribed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTest result\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot tested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emRDT negative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emRDT positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePERCEPTION AND ACCEPTABILITY\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWould visit the same CP/PPMV, next time child is sick\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWill recommend CP/PPMV to a friend seeking treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow enthusiastic are you about the availability of a test for malaria at the CP/PPMV?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot enthusiastic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnthusiastic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAttitude toward testing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReceiving a malaria test from the CP/PPMV store reduced the burden of telling the CP/PPMV about my child's symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eA malaria test result provides an objective assessment of what was wrong with my child\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIt was beneficial that my child was tested for malaria at the CP/PPMV shop\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents a multivariable adjusted analysis of the factors associated with the acceptability of the test, treatment, and referral practices for malaria. Acceptability of the test, treat, and refer practice was significantly associated with older children (more than 12 months old) [OR 4.36; 95% confidence interval (CI) 1.49, 12.74; p\u0026thinsp;=\u0026thinsp;0.007] and older caregivers (25 years and above) [OR 4.92; CI 4.6\u0026ndash;94.3; p\u0026thinsp;=\u0026thinsp;0.037]. Additionally, acceptability was also high when children were tested using mRDT [OR 5.77; CI 1.88, 17.73; p\u0026thinsp;=\u0026thinsp;0.002] and CPs/PPMVs prescribed ACT [OR 5.00; CI 1.47, 17.00; p\u0026thinsp;=\u0026thinsp;0.010]. After controlling for other factors in the adjusted analysis, the associations between acceptability and mRDT test, ACT prescription, age of sick child, and age of caregiver remained the same (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with the acceptability of the test, treatment, and referral practices for malaria.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnadjusted odds Ratio (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdjusted odds ratio (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex of sick child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.07 (0.38, 3.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.893\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.45 (0.33, 6.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.619\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of sick child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12 months or less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.36 (1.49, 12.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.72 (1.61, 37.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of caregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;24 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25 years and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.92 (1.10, 22.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.037\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.66 (1.42, 330.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.027\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest level of education attained\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school or less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.69 (0.14, 3.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.658\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.44 (0.29, 41.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.329\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026thinsp;+\u0026thinsp;years postsecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.50 (0.27, 8.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.642\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.52 (0.28, 44.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.330\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.38 (0.41, 4.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.87 (0.27, 13.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.526\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWealth index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.40 (0.66, 8.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.03 (0.60, 27.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.153\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.04 (0.30, 3.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.948\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.71 (0.10, 4.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.728\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKaduna\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLagos\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.75 (0.26, 2.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.15 (0.02, 1.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emRDT Testing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot tested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.77 (1.88, 17.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.12 (1.38, 27.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.017\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACT administered by CP/PPMV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot administered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdministered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.00 (1.47, 17.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.84 (3.44, 165.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe primary objective of this study was to assess the acceptability of the test, treatment, and referral practices for malaria management provided by CPs/PPMVs from the perspective of their clients and caregivers of children under five years of age. The research also explored the factors associated with this acceptability. This study examined three essential components of malaria management practice: testing, treating, and referring as implemented by private sector actors (CP/PPMV) at the community level. This study is one of the limited studies that specifically explored the acceptability of malaria management services, encompassing all three key aspects: testing, treating, and referring. Unlike recent studies that have focused primarily on the acceptability of services provided by community health workers, our study specifically targeted community private sector operators (CPs and PPMVs) as the service providers under consideration. The results of this study indicate that the test, treat, and refer practice received positive feedback from caregivers, as evidenced by a high level of acceptance. It is worth noting that, while the number of children referred was not substantial enough to draw definite conclusions about the association, 86% (6/7) of caregivers followed through and took their children to the referral facilities as recommended. This finding suggested a favorable response to the referral component of malaria management services.\u003c/p\u003e \u003cp\u003eOur research findings align with the results reported by a previous study conducted in Uganda (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Like this study, we found that conducting malaria testing using mRDT and prescribing appropriate medications, such as ACT, significantly influenced caregivers' acceptance of the malaria management services they received. These determinants play a crucial role in shaping caregivers' perceptions of the services provided.\u003c/p\u003e \u003cp\u003eFurthermore, the study revealed that acceptability was high for children older than one year. Additionally, there was compelling evidence indicating that caregivers aged 25 years and above were more inclined to find the services provided by CP/PPMV acceptable than their younger counterparts who sought care from the same sources. The disparity in acceptability based on the age of the caregivers might imply that older caregivers rely on their experience and personal judgment when assessing the adequacy of care provided by CP/PPMV.\u003c/p\u003e \u003cp\u003eIn contrast to the findings of the present study, earlier research conducted in Ghana revealed that the marital status of caregivers had a significant influence on the acceptance of RDT-based management of malaria (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e38\u003c/span\u003e). However, in our present study, we did not observe a significant relationship between caregiver marital status and the acceptability of the test, treat, and refer approach for malaria management. This disparity in findings could be due to differences in context or population. The study also highlights the importance of considering diverse factors that can influence acceptability when designing and implementing malaria management strategies in different regions.\u003c/p\u003e \u003cp\u003eThe findings of this study hold significant implications for multiple reasons. First, the adoption of the test, treat, and refer practice as a standard approach by CPs and PPMVs could replace the customary practice of prescribing medications without conducting tests. This shift has the potential to improve the quality of malaria management services and enhance patient outcomes. Second, clients seeking malaria management services can have higher expectations and acceptance if they are regularly offered the test, treat, or refer practice by private sector providers. This may foster greater trust and confidence in the services provided by CPs and PPMVs, leading to increased utilization and adherence to treatment recommendations. Third, the study revealed that a proportion of individuals received ACT treatment without undergoing testing, indicating a need for further interventions and training to improve the adherence of CPs and PPMVs to recommended guidelines. Similarly, the data suggest that CPs/PPMVs do not refer children with fever lasting more than seven days as per national guidelines (data not shown), signaling the necessity for targeted efforts to address this gap in adherence. Finally, these research outcomes provide valuable insights for addressing the existing gaps in the services offered by CPs and PPMVs. By identifying areas of improvement and emphasizing the implementation of standardized practices, policymakers and healthcare authorities can work toward enhancing the overall quality of malaria management services provided by private sector operators.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study is not without its limitations, which we need to consider when interpreting the results. First, there might be recall issues, as caregivers were required to remember events that occurred at least two weeks prior to the interviews. Memory accuracy over such a period could lead to potential biases in the data. Second, the study focused solely on female caregivers responsible for children under the age of five. This restricted scope may limit the generalizability of the findings to other populations. Another limitation was the nonrandom sampling method used to select participants. The convenience sampling approach, which involved specifically targeting caregivers who visited trained CPs and PPMVs who received IntegratE's intervention package, might introduce selection bias. Consequently, the findings may not be fully representative of all caregivers seeking services from private sector operators. Moreover, the absence of a comparison group, consisting of clients who visited untrained CPs and PPMVs, hinders the ability to assess the impact of the intervention accurately. It is essential to acknowledge these limitations to better contextualize and interpret the study's results.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study demonstrated that caregivers of febrile children find the test, treatment, and referral practices for malaria management to be acceptable. However, these findings also highlight a concerning issue where not all sick children were subjected to mRDT testing before receiving treatment. This indicates the need for further efforts to ensure that CPs and PPMVs adhere to standardized malaria management procedures. To improve this situation, there is a crucial necessity to raise awareness among caregivers about the importance of expecting the full spectrum of care when seeking services from trained providers such as CPs and PPMVs. Creating awareness can empower caregivers to advocate for proper testing and appropriate treatment for their children. Moreover, continued supportive supervision and monitoring should be used to ensure that CPs and PPMVs consistently follow the national guidelines for malaria management. This ongoing oversight will help reinforce adherence to established protocols and maintain the quality of care provided by these private sector operators. Overall, this study emphasizes the significant role played by CPs and PPMVs in delivering malaria management services and highlights the continuous improvement needed to optimize their contributions to public health. By addressing these challenges and implementing effective strategies, we can enhance the effectiveness and quality of malaria management in the community setting, ultimately benefiting the health and well-being of affected children and their caregivers.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eACT: Artemisinin-based combination therapy; CPs: Community Pharmacists; CIs: Confidence intervals; FP: Family Planning; ICCM: Integrated Community Case Management; IRB: Institutional Review Board; mRDT: Malaria Rapid Diagnostic Tests; NHREC: National Health Research Ethics Committee; NMEP: National Malaria Elimination Program; OR: Odds Ratio; PCN: Pharmacy Council of Nigeria; PPMVs: Patent and Proprietary Medicine Vendors; RME: Research, Monitoring and Evaluation; SSA: Sub-Saharan Africa.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: We received ethical approval from the Population Council\u0026apos;s Institutional Review Board and the National Health Research Ethics Committee (NHREC) of the Federal Ministry of Health. All participants provided verbal informed consent after we informed them about the objective of the study during the phone interview.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e:\u0026nbsp;The deidentified dataset analyzed during the current study will be available on the Population Council\u0026rsquo;s Dataverse, https://dataverse.harvard.edu/dataverse/popcouncil. The data will also be available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e:\u0026nbsp;The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e:\u0026nbsp;The research in this publication was supported by funding from The Bill \u0026amp; Melinda Gates Foundation [INV-007278, formerly OPP1173898]. The opinions and inferences made in this work are those of the authors and not the funding agencies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e:\u0026nbsp;The paper was conceived and designed by TOA and SB. The data collection was supervised by SB, TOA, TA, OU, and OM. Statistical analysis, tables and chart were prepared by TOA, and the findings were interpreted by TOA and SB. TOA prepared the first draft of the manuscript; TA drafted the Background section; OU drafted the Methods section; and EEO, SB, EDE, OU, OM, TA, TOA and RD made substantive revisions to subsequent drafts. All the authors read and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e:\u0026nbsp;This study was conducted in collaboration with the Federal Ministry of Health of Nigeria, Pharmacists Council of Nigeria, National Association of Patent and Proprietary Medicine Dealers, State Ministries of Health in Kaduna, and Lagos and the IntegratE consortium partners. We thank Dele Abegunde for his guidance during the writing of the manuscript. We appreciate the dedication and efforts of the research team and data collectors. Furthermore, we acknowledge all the caregivers who provided valuable information for this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). Guidelines for the treatment of malaria. 3rd ed. Geneva: World Health Organization. ; 2015. 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J Community Health. 2014;39(6):1171\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10900-014-9872-4\u003c/span\u003e\u003cspan address=\"10.1007/s10900-014-9872-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Malaria, Nigeria, community pharmacist, drug shop owners, private sector, acceptability","lastPublishedDoi":"10.21203/rs.3.rs-3937247/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3937247/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe burden of malaria affects children under the age of five and pregnant women, leading to high morbidity and mortality rates. In sub-Saharan Africa, Patent and Proprietary Medicine Vendors (PPMVs) have been identified as key players in the provision of malaria treatment due to their accessibility and availability in communities, but PPMVs are not usually tested before fever cases are treated as malaria or refer clients. The aim of this study was to explore the factors influencing caregivers\u0026rsquo; acceptance of the test, treatment and referral practices for malaria management provided by CPs and PPMVs in Kaduna and Lagos states, Nigeria.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional quantitative telephone survey was conducted among 150 caregivers of children under five years old who received malaria services from trained CPs and PPMVs between May and July 2022. Descriptive and bivariate analyses were performed to identify factors significantly associated with the acceptability of malaria management services. All statistically significant factors from the bivariate analysis were explored using logistic regression models, and odds ratios (ORs) with confidence intervals (CIs) were calculated to predict acceptability. The 95% level was used to define statistically significant associations (p\u0026thinsp;\u0026le;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAll caregivers were asked questions that aided in obtaining a diagnosis of malaria. More than two-thirds of the caregivers (68%) reported that the child was tested by a CP/PPMV. Among those treated (148), 89% reported that the child was administered artemisinin combination therapy (ACT) irrespective of whether the child tested positive or negative for malaria. At the bivariate level, acceptability was greater among caregivers of children aged 13 months and older than among caregivers of children aged 0\u0026ndash;12 months (93% vs. 76%, p\u0026thinsp;=\u0026thinsp;0.004). Caregivers of children prescribed ACT had greater acceptance than did those not prescribed ACT (92% vs. 69%, p\u0026thinsp;=\u0026thinsp;0.010). Multivariate analysis revealed that these relationships held.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe adoption of the test, treat, and refer practice as a standard approach by CPs and PPMVs could replace the widespread practice of prescribing medications without conducting tests. This shift has the potential to improve the quality of malaria management services and enhance patient outcomes.\u003c/p\u003e","manuscriptTitle":"Factors Influencing the Acceptability of the Test, Treat and Refer Practice for Malaria among Caregivers of Under 5 Children at Community Pharmacies and Drug Shops in Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-09 21:50:47","doi":"10.21203/rs.3.rs-3937247/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-10T15:24:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-02-22T09:49:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"dc8d8e23-1b72-42a9-b9a6-1fefef3d3cb1","date":"2024-02-12T16:55:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-02-12T15:15:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-02-08T04:52:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-02-08T04:52:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"Malaria Journal","date":"2024-02-07T15:07:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c362dab7-be87-43d5-b8a8-d9437f8eac7e","owner":[],"postedDate":"February 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-14T16:04:10+00:00","versionOfRecord":{"articleIdentity":"rs-3937247","link":"https://doi.org/10.1186/s12936-024-05114-7","journal":{"identity":"malaria-journal","isVorOnly":false,"title":"Malaria Journal"},"publishedOn":"2024-10-09 15:57:07","publishedOnDateReadable":"October 9th, 2024"},"versionCreatedAt":"2024-02-09 21:50:47","video":"","vorDoi":"10.1186/s12936-024-05114-7","vorDoiUrl":"https://doi.org/10.1186/s12936-024-05114-7","workflowStages":[]},"version":"v1","identity":"rs-3937247","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3937247","identity":"rs-3937247","version":["v1"]},"buildId":"omnImTCwR2MFx8CMYfrG7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}