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Early home treatment of childhood fevers with ineffective antimalarials is deleterious in the outcome of severe malaria
- Source :
- Malaria Journal, Malaria Journal, Vol 7, Iss 1, p 143 (2008)
- Publication Year :
- 2008
- Publisher :
- Springer Science and Business Media LLC, 2008.
-
Abstract
- Background Early diagnosis and prompt treatment including appropriate home-based treatment of malaria is a major strategy for malaria control. A major determinant of clinical outcome in case management is compliance and adherence to effective antimalarial regimen. Home-based malaria treatment with inappropriate medicines is ineffective and there is insufficient evidence on how this contributes to the outcome of severe malaria. This study evaluated the effects of pre-hospital antimalarial drugs use on the presentation and outcome of severe malaria in children in Ibadan, Nigeria. Methods Two hundred and sixty-eight children with a median age of 30 months comprising 114 children with cerebral malaria and 154 with severe malarial anaemia (as defined by WHO) were prospectively enrolled. Data on socio-demographic data, treatments given at home, clinical course and outcome of admission were collected and analysed. Results A total of 168 children had treatment with an antimalarial treatment at home before presenting at the hospital when there was no improvement. There were no significant differences in the haematocrit levels, parasite counts and nutritional status of the pre-hospital treated and untreated groups. The most commonly used antimalarial medicine was chloroquine. Treatment policy was revised to Artemesinin-based Combination Therapy (ACT) in 2005 as a response to unacceptable levels of therapeutic failures with chloroquine, however chloroquine use remains high. The risk of presenting as cerebral malaria was 1.63 times higher with pre-hospital use of chloroquine for treatment of malaria, with a four-fold increase in the risk of mortality. Controlling for other confounding factors including age and clinical severity, pre-hospital treatment with chloroquine was an independent predictor of mortality. Conclusion This study showed that, home treatment with chloroquine significantly impacts on the outcome of severe malaria. This finding underscores the need for wide-scale monitoring to withdraw chloroquine from circulation in Nigeria and efforts intensified at promoting prompt treatment with effective medicines in the community.
- Subjects :
- Male
Pediatrics
medicine.medical_specialty
lcsh:Arctic medicine. Tropical medicine
Fever
lcsh:RC955-962
Population
Nigeria
lcsh:Infectious and parasitic diseases
Antimalarials
Chloroquine
parasitic diseases
medicine
Risk of mortality
Humans
lcsh:RC109-216
Child
education
education.field_of_study
business.industry
Research
Mortality rate
Age Factors
Infant
medicine.disease
Malaria
Regimen
Treatment Outcome
Infectious Diseases
Clinical research
Socioeconomic Factors
Cerebral Malaria
Child, Preschool
Female
Parasitology
business
medicine.drug
Subjects
Details
- ISSN :
- 14752875
- Volume :
- 7
- Database :
- OpenAIRE
- Journal :
- Malaria Journal
- Accession number :
- edsair.doi.dedup.....0b07e7ebe8550797ca47107b74ca5a10