{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T05:25:17Z","timestamp":1793165117512,"version":"4.5.0"},"reference-count":84,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2021,11,5]],"date-time":"2021-11-05T00:00:00Z","timestamp":1636070400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wellcome Trust, DELTAS Africa Initiative","award":["107769\/Z\/10\/Z"],"award-info":[{"award-number":["107769\/Z\/10\/Z"]}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["103602"],"award-info":[{"award-number":["103602"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["212176"],"award-info":[{"award-number":["212176"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100013986","name":"UK government","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100013986","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["203077"],"award-info":[{"award-number":["203077"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["203077"],"award-info":[{"award-number":["203077"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["203077"],"award-info":[{"award-number":["203077"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["203077"],"award-info":[{"award-number":["203077"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Health workers\u2019 compliance with outpatient malaria case-management guidelines has been improving in Africa. This study examined the factors associated with the improvements.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Data from 11 national, cross-sectional health facility surveys undertaken from 2010\u20132016 were analysed. Association between 31 determinants and improvement trends in five outpatient compliance outcomes were examined using interactions between each determinant and time in multilevel logistic regression models and reported as an adjusted odds ratio of annual trends (T-aOR).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Among 9,173 febrile patients seen at 1,208 health facilities and by 1,538 health workers, a higher annual improvement trend in composite \u201ctest and treat\u201d performance was associated with malaria endemicity-lake endemic (T-aOR = 1.67 annually; p&lt;0.001) and highland epidemic (T-aOR = 1.35; p&lt;0.001) zones compared to low-risk zone; with facilities stocking rapid diagnostic tests only (T-aOR = 1.49; p&lt;0.001) compared to microscopy only services; with faith-based\/non-governmental facilities compared to government-owned (T-aOR = 1.15; p = 0.036); with a daily caseload of &gt;25 febrile patients (T-aOR = 1.46; p = 0.003); and with under-five children compared to older patients (T-aOR = 1.07; p = 0.013). Other factors associated with the improvement trends in the \u201ctest and treat\u201d policy components and artemether-lumefantrine administration at the facility included the absence of previous RDT stock-outs, community health workers dispensing drugs, access to malaria case-management and Integrated Management of Childhood Illness (IMCI) guidelines, health workers\u2019 gender, correct health workers\u2019 knowledge about the targeted malaria treatment policy, and patients\u2019 main complaint of fever. The odds of compliance at the baseline were variable for some of the factors.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Targeting of low malaria risk areas, low caseload facilities, male and government health workers, continuous availability of RDTs, improving health workers\u2019 knowledge about the policy considering age and fever, and dissemination of guidelines might improve compliance with malaria guidelines. For prompt treatment and administration of the first artemether-lumefantrine dose at the facility, task-shifting duties to community health workers can be considered.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0259020","type":"journal-article","created":{"date-parts":[[2021,11,5]],"date-time":"2021-11-05T17:28:56Z","timestamp":1636133336000},"page":"e0259020","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Determinants of improvement trends in health workers\u2019 compliance with outpatient malaria case-management guidelines at health facilities with available \u201ctest and treat\u201d commodities in Kenya"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5754-3853","authenticated-orcid":true,"given":"Beatrice","family":"Amboko","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasia","family":"Stepniewska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Malla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Machini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Bejon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3725-6088","authenticated-orcid":true,"given":"Robert W.","family":"Snow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dejan","family":"Zurovac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,11,5]]},"reference":[{"key":"pone.0259020.ref001","author":"World Health Organization","year":"2015"},{"key":"pone.0259020.ref002","doi-asserted-by":"crossref","DOI":"10.30875\/7e6f8c91-en","volume-title":"World Malaria Report 2019","author":"World Health Organization","year":"2019"},{"key":"pone.0259020.ref003","volume-title":"Guidelines for the treatment of malaria","author":"World Health Organization","year":"2010"},{"key":"pone.0259020.ref004","volume-title":"Guidelines for the treatment of malaria","author":"World Health 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