On 2015 Dec 05, Siddharudha Shivalli commented:

Siddharudha Shivalli (2015-12-04 11:25) Yenepoya Medical College, Yenepoya University, Mangaluru, Karnataka, India email

I read the article by Salomão CA et al, with a great interest. Authors’ efforts are commendable. Based on a large scale hospital based survey, authors demonstrate the poor adherence to the new guidelines for malaria treatment among health care workers in Mozambique and higher prescription of ACT to malaria negative patients.

In method section, authors stated that only districts that were accessible by road were selected. Authors should have mentioned the approx proportion of districts in 11 provinces of Mozambique which are not accessible by road. If it amounts to a substantial proportion then study findings may not be applicable for these districts. In addition, method of selection of each health centre from each stratum is not clear (i.e. random or purposive).

It appears that both healthcare worker and clinician can prescribe anti-malarial drugs in the study setting. If so, overuse of ACT in malaria negative patients according to health cadre (clinician vs. healthcare worker) would have been more interesting and informative. Authors should have briefly explained the existing healthcare delivery system and strategies in the study setting with reference to malaria.

In Table 1 and throughout the article, authors have mentioned the p value as ‘0.000’. Statistical software, by default setting, displays p value as zero if it extends beyond 3 decimal points (i.e. p=0.0000001 would be displayed as p=0.00). Practically, the value of p cannot be zero and hence, I would suggest to report it as p<0.0001.

Nonetheless, I must congratulate the authors for exploring an important public health problem in the study area.

Competing interests:The author declares that there is no conflict of interest about this publication

On 2015 Dec 05, Siddharudha Shivalli commented:

Siddharudha Shivalli (2015-12-04 11:25) Yenepoya Medical College, Yenepoya University, Mangaluru, Karnataka, India email

I read the article by Salomão CA et al, with a great interest. Authors’ efforts are commendable. Based on a large scale hospital based survey, authors demonstrate the poor adherence to the new guidelines for malaria treatment among health care workers in Mozambique and higher prescription of ACT to malaria negative patients.

In method section, authors stated that only districts that were accessible by road were selected. Authors should have mentioned the approx proportion of districts in 11 provinces of Mozambique which are not accessible by road. If it amounts to a substantial proportion then study findings may not be applicable for these districts. In addition, method of selection of each health centre from each stratum is not clear (i.e. random or purposive).

It appears that both healthcare worker and clinician can prescribe anti-malarial drugs in the study setting. If so, overuse of ACT in malaria negative patients according to health cadre (clinician vs. healthcare worker) would have been more interesting and informative. Authors should have briefly explained the existing healthcare delivery system and strategies in the study setting with reference to malaria.

In Table 1 and throughout the article, authors have mentioned the p value as ‘0.000’. Statistical software, by default setting, displays p value as zero if it extends beyond 3 decimal points (i.e. p=0.0000001 would be displayed as p=0.00). Practically, the value of p cannot be zero and hence, I would suggest to report it as p<0.0001.

Nonetheless, I must congratulate the authors for exploring an important public health problem in the study area.

Competing interests:The author declares that there is no conflict of interest about this publication