PO-0230 Management Of Severe Malaria In Children, An Audit Of Clinical Practise In A Rural Hospital In Zambia

Abstract

Introduction The malarial mortality rate remains highest in African infants and children. The purpose of this audit was to review our clinical practice and to assess our compliance with the WHO guideline for the management of severe malaria. Method A retrospective chart review of malaria cases over 14 weeks was undertaken. 43 cases of malaria in paediatric inpatients were identified. Data extraction included duration and nature of presenting symptoms, clinical signs recorded, time to diagnosis, time to anti-malarial treatment and fluid management. Results There were 43 cases of malaria, 20 males, 23 females, median age 3 years (3 mths - 12 years), median length of stay 4.3 days (1–11 days). 35/40 (80%) of these cases were classified severe malaria by WHO criteria. The overall mortality rate was 16.3%. 29/40 (73%) were diagnosed prior to admission: only 22(55%) received a first dose of anti malarial drug within 4 h of presentation. 12% experienced significant diagnostic delays. No child received either normal saline or albumin bolus. 12% received a bolus of dextrose. 10 patients (25%) received blood transfusions. 30 patients (75%) received intravenous quinine, as artesunate, the WHO recommended first line for the treatment of severe malaria, is not currently available in our hospital. Discussion Children hospitalised with malaria in rural Zambia continue to have unacceptably high mortality. This audit highlights the importance of urgent medical review, need for earlier diagnosis and prompt initiation of better antimalarial agents. Late diagnosis and lack of availability of artesunate were identified as potential significant contributors to the high mortality rates in this audit.