DISCUSSION
respiratory infections, fever, malaria, respiratory diseases, acute febrile illness, coronavirus disease 2019
RESPIRATORY INFECTIONS, RESPIRATORY DISEASE, CORONAVIRUS DISEASE 2019, MALARIA, DISEASE
We aimed to compare the impact of point-of-care rapid diagnostic tests in a diagnostic algorithm on antibiotic prescriptions for acute febrile illness as well as clinical outcomes and adherence of patients and caregivers. The majority of enrolled patients had a favorable outcome in terms of resolution of fever and other clinical symptoms in both arms, irrespective of the treatment received.Overall, there was no statistically significant reduction in antibiotic prescriptions in the intervention arm. However, there were significant reductions when antibiotic prescriptions were stratified by age and disease: in children aged <5 years and in patients without malaria (RDT-negative) and with respiratory symptoms and diagnosed as having respiratory diseases. This is in line with the results of the same study conducted in Burkina Faso and Uganda during the same period (September 2020 to September 2021).The difference in antibiotic prescriptions across the 2 arms in our study, even though smaller and not close to the anticipated 30% reduction, reveals the role of POCTs, which are effective in primary care settings in the fight against inappropriate antibiotic prescription and antibiotic resistance [The proportion of antibiotics prescribed in the intervention arm was lower compared with similar studies that examined acute febrile illness in Ghana at 70.1% [A recent point prevalence survey conducted in a tertiary health facility in Ghana showed the proportion of antibiotic prescriptions to be 51.4% [A high level of adherence to prescriptions was observed in both arms. This could not be attributed to the impact of the behavioral change communication that was administered only to the intervention arm. Adherence at the participant level is usually influenced by different determinants, and it will be interesting to conduct future studies in order to determine the reasons behind this high level in the context of the study area. It is important not to discount the possible effect of residual contamination among participants through communication at the household level and among prescribers through work interactions despite the steps taken to minimize it.Limitations of our study include the significantly low levels of confirmed respiratory infections by the rapid diagnostic tests. This could be explained by the period in which the study was undertaken. The study was conducted during the coronavirus disease 2019 pandemic just after the first major wave and throughout the second wave [