Although case scenarios were not clearly defined, and therefore were not necessarily indicative of prescriber knowledge, they did raise some concerns. While all CBC prescribers should have access to a copy of the standard treatment guidelines and were told they could use any available resource to complete the case scenarios, many prescribers did not prescribe a treatment in accordance with the guidelines. This confirms Hogerzeil's 1994 findings that the existence of standard treatment guidelines is not in itself an effective tool in influencing prescribers' behaviour.
Another concern was how the dosage, especially for quinine, was written. As mentioned earlier, few prescribers included the total number of tablets needed and often the dosage did not correspond to a dosage stocked in the pharmacy. This raises the concern that dispensers who may not have appropriate training, are left to calculate the proper strength and quantity of tablets to give to the patient.
Despite the questionable reliability of the results of the case scenarios, feedback from prescribers indicated that the case scenarios method is a useful way of determining adherence to standard treatment guidelines, particularly when substantiated by drug indicators such as chloroquine and quinine prescription rates. Periodic testing using case scenarios may also serve as a reminder to prescribers to use the standard treatment guidelines as well as indicate discrepancies between the guidelines and common practices among prescribers. It is also important to note that in this study the WHO complementary indicator "prescription in accordance with standard treatment guidelines" was modified to also include diagnosis.