Open Access Open Badges Research article

Predictors of antibiotics co-prescription with antimalarials for patients presenting with fever in rural Tanzania

Mustafa Njozi12*, Mbaraka Amuri23, Majige Selemani12, Irene Masanja12, Brown Kigahe12, Rashid Khatib12, Dan Kajungu2, Salim Abdula1 and Alexander N Dodoo2

Author Affiliations

1 Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania

2 INDEPTH Network Effectiveness and Safety Studies of Antimalarial in Africa (INESS), Accra, Ghana

3 Jhpiego, P.O Box 9170, Dar es Salaam, Tanzania

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BMC Public Health 2013, 13:1097  doi:10.1186/1471-2458-13-1097

Published: 27 November 2013



Successful implementation of malaria treatment policy depends on the prescription practices for patients with malaria. This paper describes prescription patterns and assesses factors associated with co-prescription of antibiotics and artemether-lumefantrine (AL) for patients presenting with fever in rural Tanzania.


From June 2009 to September 2011, a cohort event monitoring program was conducted among all patients treated at 8 selected health facilities in Ifakara and Rufiji Health and Demographic Surveillance System (HDSS). It included all patients presenting with fever and prescribed with AL. Logistic regression was used to model the predictors on the outcome variable which is co-prescription of AL and antibiotics on a single clinical visit.


A cohort of 11,648 was recruited and followed up with 92% presenting with fever. Presumptive treatment was used in 56% of patients treated with AL. On average 2.4 (1 – 7) drugs was prescribed per encounter, indicating co-prescription of AL with other drugs. Children under five had higher odds of AL and antibiotics co-prescription (OR = 0.63, 95% CI: 0.46 – 0.85) than those aged more than five years. Patients testing negative had higher odds (OR = 2.22, 95% CI: 1.65 – 2.97) of AL and antibiotics co-prescription. Patients receiving treatment from dispensaries had higher odds (OR = 1.45, 95% CI: 0.84 – 2.30) of AL and antibiotics co-prescription than those served in health centres even though the deference was not statistically significant.


Regardless the fact that Malaria is declining but due to lack of laboratories and mRDT in most health facilities in the rural areas, clinicians are still treating malaria presumptively. This leads them to prescribe more drugs to treat all possibilities.

Cohort event monitoring; Antibiotics; Co-prescription; Artemether-lumefantrine; Tanzania