Management of Uncomplicated Malaria in Underfives in Private and Public Health Facilities in South-Eastern Nigeria: A Clinical Audit of Current Practices
Malaria remains a leading cause of underfive morbidity and mortality in sub-Saharan Africa. Effective case management is a strategy recommended by the World Health Organization for its control. A clinical audit of case management of uncomplicated malaria in underfives in health facilities in Cross River State, Nigeria, was conducted from January to March 2012. Data was extracted from patients’ case records by trained medical personnel using pretested data extraction forms. Of the 463 case records reviewed, age, gender, and weight were reported in 98.1%, 97.3%, and 49.7% of the children, respectively. A history of fever was obtained in 89.6% and a record of temperature in 74.1% of the children. General examination was performed in 203 (43.8%) children. Malaria parasite test was requested in 132 (28.5%) while Packed cell volume or haemoglobin was requested in 107 (23.1%) children. Appropriate dose of Artemisinin Combination Therapy (ACT) was instituted in 300 (64.8%), wrong dose in 109 (23.5%), and inappropriate treatment in 41 (8.9%). The utilization of ACTs for treating uncomplicated malaria in the State has improved but clinical assessment of patients and laboratory confirmation of diagnosis are suboptimum. 1. Background Malaria remains a leading cause of childhood illness and death in sub-Saharan Africa with an underfive annual mortality of approximately a million [1]. It is the most significant public health problem in Nigeria where it accounts for 25% of underfive mortality and 30% of childhood mortality. About 50% of the population will have at least one episode of malaria annually while about 24 million underfives will have 2 to 4 attacks of malaria annually [2]. Effective case management of uncomplicated malaria is a major strategy for malaria control. This entails proper clinical assessment, laboratory confirmation of the disease either by light microscopy or rapid diagnostic technique (RDT) prior to treatment with an effective antimalarial [3]. Plasmodium falciparum (P. falciparum) is the most virulent of all the species that infect humans and accounts for over 95% of malaria-related morbidity and mortality in the country [4]. Chloroquine (CQ) and Sulfadoxine-pyrimethamine (SP) were used as first-and second-line treatment, respectively, for uncomplicated malaria until the emergence and intensification of parasite resistance to these drugs which necessitated a review of the antimalarial treatment policy [5, 6]. The Nigerian government changed the treatment policy for uncomplicated malaria to the Artemisinin Combination Therapy (ACT) in 2005 in
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