Abstract
BackgroundThe acceptability and efficacy of a new kit with a new formulation of quinine alkaloids designed for the intra-rectal administration in the treatment of non-per os malaria was assessed in the peripheral health care system of Mopti, Mali.MethodsA single-arm trial was conducted from August 2003 to January 2004. An initial dose of diluted quinine alkaloids (20 mg/kg Quinimax®) was administered by the intra-rectal route to children with presumptive non per-os malaria at six peripheral heath care centres. The children were then referred to two referral hospitals where standard inpatient care including intravenous route were routinely provided. A malaria thick smear was done at inclusion and a second malaria thick smear after arrival at the referral facility, where a more complete clinical examination and laboratory testing was done to confirm diagnosis. Confirmed cases of severe malaria or others diseases were treated according to national treatment guidelines. Cases of non per-os malaria received a second dose of intra rectal quinine alkaloids. Primary outcome was acceptability of the intra rectal route by children and their parents as well as the ease to handle the kit by health care workers.ResultsThe study included 134 children with a median age of 33 months and 53.7% were male. Most of the children (67%) and 92% of parents or guardians readily accepted the intra-rectal route; 84% of health care workers found the kit easy to use. At the peripheral health care centres, 32% of children had a coma score ≤ 3 and this was reduced to 10% at the referral hospital, following one dose of intra-rectal quinine alkaloids (IRQA). The mean time to availability of oral route treatment was 1.8 ± 1.1 days. Overall, 73% of cases were confirmed severe malaria and for those the case fatality rate was 7.2%.ConclusionIRQA was well accepted by children, their parents/guardians and by the health workers at peripheral health facilities in Mopti, Mali. There was also a quick recovery from deep coma and a reduced case fatality rate in severe malaria.
Highlights
The acceptability and efficacy of a new kit with a new formulation of quinine alkaloids designed for the intra-rectal administration in the treatment of non-per os malaria was assessed in the peripheral health care system of Mopti, Mali
The treatment of severe malaria episodes solely at the level of hospital bears the risk of increasing malaria case fatality rates
Out of 133 children that arrived at the referral centre, 97 (73%) had malaria smear positive for P. falciparum
Summary
The acceptability and efficacy of a new kit with a new formulation of quinine alkaloids designed for the intra-rectal administration in the treatment of non-per os malaria was assessed in the peripheral health care system of Mopti, Mali. Clinical malaria can be severe right from its onset. This is strongly related to individual susceptibilities [1] and often caused by delayed access to appropriate treatment. Delayed access to appropriate treatment is known to lead to increased mortality related to severe malaria [2,3]. In developing countries such as Mali, West Africa, the health care system is organized to allow treatment of severe malaria at the hospital level. The treatment of severe malaria episodes solely at the level of hospital bears the risk of increasing malaria case fatality rates. The fact that most of deaths recorded at hospitals occurred during the first 24 hours after admission [6,7] highlights the need for earlier actions to reduce case fatality rates
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