BACKGROUND: Appropriate diagnosis and treatment are essential for reducing @entity311 mortality. A cross-sectional outpatient health facility (HF) survey was conducted in southern Malawi from January to March 2015 to determine appropriate @entity311 testing and treatment practices four years after implementation of a policy requiring diagnostic confirmation before treatment. METHODS: Enrolled @entity1 were interviewed, examined and had their health booklet reviewed. Health workers (HWs) were asked about training, supervision and access to the 2013 national @entity311 treatment guidelines. HFs were assessed for @entity311 diagnostic and treatment capacity. Weighted descriptive analyses and logistic regression of @entity1 , HW and HF characteristics related to testing and treatment were performed. RESULTS: An evaluation of 105 HFs, and interviews of 150 HWs and 2342 @entity1 was completed. Of 1427 suspect uncomplicated @entity311 @entity1 seen at HFs with testing available, 1072 (75.7%) were tested, and 547 (53.2%) tested positive. Testing was more likely if @entity1 spontaneously reported fever (odds ratio (OR)  2.6; 95% confidence interval (CI) 1.7-4.0), @entity10 (OR 1.5; 95% CI 1.1-2.1) or @entity391 (OR 2.0; 95% CI 1.0-4.0) to HWs and less likely if they reported skin problems (OR 0.4; 95% CI 0.2-0.6). Altogether, 511 (92.7%) confirmed cases and 98 (60.3%) of 178 presumed uncomplicated @entity311 @entity1 (at HFs without testing) were appropriately treated, while 500 (96.6%) of 525 @entity1 with negative tests did not receive anti-malarials. Only eight (5.7%) suspect severe @entity311 @entity1 received appropriate pre-referral treatment. Appropriate treatment was more likely for presumed uncomplicated @entity311 @entity1 (at HFs without testing) with elevated temperature (OR 1.5/1    C increase; 95% CI 1.1-1.9), who reported fever to HWs (OR 5.7; 95% CI 1.9-17.6), were seen by HWs with additional supervision visits in the previous 6  months (OR 1.2/additional visit; 95% CI 1.0-1.4), or were seen by older HWs (OR 1.1/year of age; 95% CI 1.0-1.1). CONCLUSIONS: Correct testing and treatment practices were reasonably good for uncomplicated @entity311 when testing was available. Pre-referral treatment for suspect severe @entity311 was unacceptably rare. Encouraging HWs to elicit and appropriately respond to @entity1 symptoms may improve practices.

Health worker adherence to XXXX treatment guidelines at outpatient health facilities in southern Malawi following implementation of universal access to diagnostic testing.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity311 :: ('MESH:D008288', 'Disease') :: ['malaria'] @entity10 :: ('MESH:D006261', 'Disease') :: ['headache'] @entity391 :: ('MESH:D014839', 'Disease') :: ['vomiting']
@entity311 :: (MESH:D008288,Disease) :: ['malaria']
