The impact of user fees on health services utilization and infectious disease diagnoses in Neno District, Malawi: a longitudinal, quasi-experimental study

Table 2 Main results: estimated effect of the presence of user fees on monthly attendances and diagnoses at health centres in Neno District, Malawi

	Total outpatient attendances (subject to user fees)	Total new malaria diagnoses, under 5 s	Total new malaria diagnoses, over 5 s	New confirmed HIV+ patient, aged 15–49
Periods 1 and 2: Introduction of user fees^a
Estimated change (%)	−68	−18	−56	−48
95 % confidence interval	[−89, −12]	[−73, 144]	[−83, 14]	[−64, −25]
P-value	0 · 048	0 · 70	0 · 084	0 · 002
Number of centres	13	13	13	13
Number of months	35	35	35	35
Periods 2 and 3: Removal of user fees^b
Estimated change (%)	352	230	247	-^c
95 % confidence interval	[213, 554]	[106, 430]	[171, 343]	-
P-value	<0 · 001	<0 · 001	<0 · 001	-
Number of centres	13	13	13	13
Number of months	27	27	27	27

The estimated change represents the average difference in monthly attendances or diagnoses associated with the introduction or removal of user fees
^aEstimated using data from the period July 2012 to June 2015
^bEstimated using data from the period August 2013 to October 2015
^cThere were two few new confirmed HIV+ patients treated at the centre which removed user fees to analyse