Abstract

BackgroundEarly diagnosis and prompt treatment including appropriate home-based treatment of malaria is a major strategy for malaria control. A major determinant of clinical outcome in case management is compliance and adherence to effective antimalarial regimen. Home-based malaria treatment with inappropriate medicines is ineffective and there is insufficient evidence on how this contributes to the outcome of severe malaria. This study evaluated the effects of pre-hospital antimalarial drugs use on the presentation and outcome of severe malaria in children in Ibadan, Nigeria.MethodsTwo hundred and sixty-eight children with a median age of 30 months comprising 114 children with cerebral malaria and 154 with severe malarial anaemia (as defined by WHO) were prospectively enrolled. Data on socio-demographic data, treatments given at home, clinical course and outcome of admission were collected and analysed.ResultsA total of 168 children had treatment with an antimalarial treatment at home before presenting at the hospital when there was no improvement. There were no significant differences in the haematocrit levels, parasite counts and nutritional status of the pre-hospital treated and untreated groups. The most commonly used antimalarial medicine was chloroquine. Treatment policy was revised to Artemesinin-based Combination Therapy (ACT) in 2005 as a response to unacceptable levels of therapeutic failures with chloroquine, however chloroquine use remains high. The risk of presenting as cerebral malaria was 1.63 times higher with pre-hospital use of chloroquine for treatment of malaria, with a four-fold increase in the risk of mortality. Controlling for other confounding factors including age and clinical severity, pre-hospital treatment with chloroquine was an independent predictor of mortality.ConclusionThis study showed that, home treatment with chloroquine significantly impacts on the outcome of severe malaria. This finding underscores the need for wide-scale monitoring to withdraw chloroquine from circulation in Nigeria and efforts intensified at promoting prompt treatment with effective medicines in the community.

Highlights

  • Diagnosis and prompt treatment including appropriate home-based treatment of malaria is a major strategy for malaria control

  • A total number of 268 children presenting with fever, malaria parasitaemia and clinical features consistent with the WHO [22] criteria of severe malarial anaemia (SMA) and cerebral malaria (CM) were recruited consecutively at the Children's Emergency Ward and Children Out-Patient Clinic of the University College Hospital, Ibadan and the Adeoyo Maternity Hospital, Ibadan

  • The median age of patients who had prehospital treatment, 31.5 months was significantly higher than 25.5 months in those who did not receive antimalarial treatment (p = 0.013)

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Summary

Introduction

Diagnosis and prompt treatment including appropriate home-based treatment of malaria is a major strategy for malaria control. A major determinant of clinical outcome in case management is compliance and adherence to effective antimalarial regimen. Home-based malaria treatment with inappropriate medicines is ineffective and there is insufficient evidence on how this contributes to the outcome of severe malaria. This study evaluated the effects of pre-hospital antimalarial drugs use on the presentation and outcome of severe malaria in children in Ibadan, Nigeria. Prompt evaluation of all febrile illness, case-recognition and use of appropriate antimalarial therapy are essential to malarial control in order to optimize clinical outcomes of malaria-infected patients. Help from the public health services is usually sought only if the home based treatment is considered ineffective [8,9]. Pre-hospital use of antimalarial drugs may confound some of the symptoms and signs that may be useful in assessment and appropriate management decisions in the hospital

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