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South African Journal of Child Health

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

A Chiabi, V Takou, P-F Tchokoteu, S Ngo, L Essoh

Abstract


Background. Severe malaria, caused by Plasmodium falciparum, is potentially fatal, with a case mortality rate of 15 - 20%, despite treatment.
Aim. To document epidemiological and clinical features, including initial treatment, of severe malaria in children referred to a general paediatric unit in Cameroon.
Methods. A prospective cross-sectional study investigating characteristics of children admitted for severe malaria, confirmed
with a positive thick blood smear.
Results. A total of 309 (29.2%) children were identified out of 1 060 admissions, of whom 52% were males and 48% females, and mean age 46.3 (1 - 180) months. Most children were aged <3 years; 43% were 1 - 3 years. The mean duration of symptoms before admission was 3.9 days (range: 1 - 30 days). Hyperpyrexia, severe anaemia and convulsions were the main clinical features in 37%, 32% and 25% cases respectively. In 60% of the subjects, some form of treatment had been administered at home, and 33% had consulted a primary health facility. In 85% of the malaria-infected children, quinine,  artemisinin-based combination therapies (ACTs) and amodiaquine were respectively administered to 32%, 30% and 23% of the children. In ACTstreated patients, 49% received inadequate doses; drugs used in their order of frequency were artemether + lumefantrine (76%),
artesunate + amodiaquine (18%), and artesunate + mefloquine (6%). Only 16% of the mothers said they had used insecticidetreated
bed nets (ITNs).
Conclusion. In most cases, there is a delay before consultation, with most children initially self-medicated at home. Initial consultations are at primary local health facilities where less effective drugs are prescribed at inadequate dosages. Recommended ACTs were also often prescribed at inadequate dosages. Education in the use of ITNs, home treatment of simple malaria, and appropriate use of ACTs should be promoted.



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