Presumptive Diagnosis and Treatment of Malaria in Febrile Children in Parts of South Eastern Nigeria

Abstract

Background: Malaria treatment in Nigeria and other Sub-Saharan Africa is largely based on presumptive diagnosis leading to poor management of non-malaria febrile illness and abuse of antimalarial drugs. Objectives: To evaluate malaria treatments based on presumptive diagnosis and describe the actual density of uncomplicated malaria among febrile children in South Eastern Nigeria. Methods: Parasitological diagnosis using microscopy was done among 560 febrile children, 0-12 years attending Paediatric Clinics in a tertiary health facility in the study area. Their blood samples were collected prior to malaria treatment using IMCI guidelines and standard routine clinical practice. These children were grouped into under 5 years and 5-12 years. Data was analysed using SPSS. Results: Out of 560 children (0-12 years) enrolled in this study, 156(27.9%) were positive for malaria parasites, while 404(72.1%) were negative. Children’s age was significantly related to the prevalence of uncomplicated malaria (p<0.05) and a high determinant in explaining 6.4% of the variance in the prevalence of uncomplicated malaria (F=37.915 and p<0.05). Children 5-12 years (51.9%) had higher parasite density (40,678.2 P/μl) compared to those less than 5. The negative result of 72.1% indicated possibility of overtreatment with antimalarial. Conclusion: The findings highlight the need for the scaling-up of parasitological confirmation of all malaria suspected cases before treatment with the artemesinin-based combination therapies. Improving the diagnostic system for effective health care delivery in endemic areas will not only provide a good platform for malaria treatment/ monitoring but also reduce rapid onset of drug resistance.