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Prereferral rectal artesunate and referral completion among children with suspected severe malaria in the Democratic Republic of the Congo, Nigeria and Uganda.
Brunner, Nina C; Omoluabi, Elizabeth; Awor, Phyllis; Okitawutshu, Jean; Tshefu Kitoto, Antoinette; Signorell, Aita; Akano, Babatunde; Ayodeji, Kazeem; Okon, Charles; Yusuf, Ocheche; Athieno, Proscovia; Kimera, Joseph; Tumukunde, Gloria; Angiro, Irene; Kalenga, Jean-Claude; Delvento, Giulia; Lee, Tristan T; Lambiris, Mark J; Ross, Amanda; Cereghetti, Nadja; Visser, Theodoor; Napier, Harriet G; Buj, Valentina; Burri, Christian; Lengeler, Christian; Hetzel, Manuel W.
  • Brunner NC; Swiss Tropical and Public Health Institute, Allschwil, Switzerland nina.brunner@swisstph.ch manuel.hetzel@swisstph.ch.
  • Omoluabi E; University of Basel, Basel, Switzerland.
  • Awor P; Akena Associates, Abuja, Nigeria.
  • Okitawutshu J; Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda.
  • Tshefu Kitoto A; Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
  • Signorell A; Community Health, Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo.
  • Akano B; Community Health, Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo.
  • Ayodeji K; Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
  • Okon C; University of Basel, Basel, Switzerland.
  • Yusuf O; Akena Associates, Abuja, Nigeria.
  • Athieno P; Akena Associates, Abuja, Nigeria.
  • Kimera J; Akena Associates, Abuja, Nigeria.
  • Tumukunde G; Akena Associates, Abuja, Nigeria.
  • Angiro I; Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda.
  • Kalenga JC; Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda.
  • Delvento G; Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda.
  • Lee TT; Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda.
  • Lambiris MJ; Community Health, Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo.
  • Ross A; Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
  • Cereghetti N; University of Basel, Basel, Switzerland.
  • Visser T; Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
  • Napier HG; University of Basel, Basel, Switzerland.
  • Buj V; Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
  • Burri C; University of Basel, Basel, Switzerland.
  • Lengeler C; Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
  • Hetzel MW; University of Basel, Basel, Switzerland.
BMJ Glob Health ; 7(5)2022 05.
Article in English | MEDLINE | ID: covidwho-1896052
ABSTRACT

INTRODUCTION:

Children who receive prereferral rectal artesunate (RAS) require urgent referral to a health facility where appropriate treatment for severe malaria can be provided. However, the rapid improvement of a child's condition after RAS administration may influence a caregiver's decision to follow this recommendation. Currently, the evidence on the effect of RAS on referral completion is limited.

METHODS:

An observational study accompanied the roll-out of RAS in three malaria endemic settings in the Democratic Republic of the Congo (DRC), Nigeria and Uganda. Community health workers and primary health centres enrolled children under 5 years with suspected severe malaria before and after the roll-out of RAS. All children were followed up 28 days after enrolment to assess their treatment-seeking pathways.

RESULTS:

Referral completion was 67% (1408/2104) in DRC, 48% (287/600) in Nigeria and 58% (2170/3745) in Uganda. In DRC and Uganda, RAS users were less likely to complete referral than RAS non-users in the pre-roll-out phase (adjusted OR (aOR)=0.48, 95% CI 0.30 to 0.77 and aOR=0.72, 95% CI 0.58 to 0.88, respectively). Among children seeking care from a primary health centre in Nigeria, RAS users were less likely to complete referral compared with RAS non-users in the post-roll-out phase (aOR=0.18, 95% CI 0.05 to 0.71). In Uganda, among children who completed referral, RAS users were significantly more likely to complete referral on time than RAS non-users enrolled in the pre-roll-out phase (aOR=1.81, 95% CI 1.17 to 2.79).

CONCLUSIONS:

The findings of this study raise legitimate concerns that the roll-out of RAS may lead to lower referral completion in children who were administered prereferral RAS. To ensure that community-based programmes are effectively implemented, barriers to referral completion need to be addressed at all levels. Alternative effective treatment options should be provided to children unable to complete referral. TRIAL REGISTRSTION NUMBER NCT03568344; ClinicalTrials.gov.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Malaria / Antimalarials Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Child / Child, preschool / Humans Country/Region as subject: Africa Language: English Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Malaria / Antimalarials Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Child / Child, preschool / Humans Country/Region as subject: Africa Language: English Year: 2022 Document Type: Article