Initial treatment of severe malaria in children is inadequate – a study from a referral hospital in Camerooon

Abstract

ABSTRACT:
Background: Severe malaria, caused by Plasmodium falciparum, is a potentially fatal disease, with a case mortality rate of 15–20% despite adequate treatment and access to facilities for intensive treatment, and continues to threaten the survival of young children in sub-Saharan Africa.
Aim: To study the epidemiological, clinical and therapeutic features of severe malaria in children in a referral hospital in Cameroon.
Study design and setting: A prospective cross-sectional study on children admitted in the general pediatric unit of the Yaounde Gynaeco- Obstetric and Pediatric hospital, Cameroon.
Method: The epidemiological, clinical and therapeutic features of all children
admitted for severe malaria confirmed with a positive thick blood smear.
Results : A total of 309 children were studied, out of a total of 1060 admissions, giving a frequency of 29.2%. There were 161 males (52%) and 148 females (48%) with a mean age of 46.3 months (range 1-180 months). Most cases occurred before the age of 3 years with a peak frequency of 132 patients (42.7%) between the 1-3 years age group. The mean duration of symptoms before admission was 3.9 days (range:1-30days). Concerning symptomatology, hyperpyrexia, severe anemia and convulsions were main clinical features in 36.6%, 32% and 24.6% cases respectively. In 185 children (59,8%) some form of treatment had been administered at home, 102(33%) had consulted in another health facility and in 22(7%) no prior treatment had been administered. In 170 children (55%), antimalarial treatment had been administered with adequate doses in only 122 children (72%). Quinine, artemisinin- based combination therapies (ACTs) and amodiaquine were the most administered in 32.1%, 29.6% and 23% respectively. The ACTs received in order of frequency were artemether + lumefantrine in 38(76%), artesunate + amodiaquine in 9(18%) and artesunate + mefloquine in 3(6%). Amongst those who had received ACTs, 49% had inadequate doses. Only 49(16%) of the mothers admitted having insecticide treated bed nets (ITN).
Conclusion : There is a long delay before consultation, with most children initially managed with auto-medications at home. Initial consultations are in primary local health facilities where inappropriate drugs are prescribed at inadequate doses and moreover recommended ACTs at inadequate doses and ITNs are not readily used.
Recommendation : Sensitization on the use of ITNs, home treatment of simple malaria, and rational use of ACTs should be reinforced.