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Adherence to national guidelines for the diagnosis and management of severe malaria: a nationwide, cross-sectional survey in Malawi, 2012.
Shah, Monica P; Briggs-Hagen, Melissa; Chinkhumba, Jobiba; Bauleni, Andy; Chalira, Alfred; Moyo, Dubulao; Dodoli, Wilfred; Luhanga, Misheck; Sande, John; Ali, Doreen; Gutman, Julie; Mathanga, Don P; Lindblade, Kim A.
Affiliation
  • Shah MP; Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-06, Atlanta, GA, 30333, USA. MShah2@cdc.gov.
  • Briggs-Hagen M; Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-06, Atlanta, GA, 30333, USA.
  • Chinkhumba J; Malaria Alert Centre, Malawi College of Medicine, Blantyre, Malawi.
  • Bauleni A; Malaria Alert Centre, Malawi College of Medicine, Blantyre, Malawi.
  • Chalira A; National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi.
  • Moyo D; National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi.
  • Dodoli W; World Health Organization, Lilongwe, Malawi.
  • Luhanga M; National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi.
  • Sande J; National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi.
  • Ali D; National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi.
  • Gutman J; Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-06, Atlanta, GA, 30333, USA.
  • Mathanga DP; Malaria Alert Centre, Malawi College of Medicine, Blantyre, Malawi.
  • Lindblade KA; Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-06, Atlanta, GA, 30333, USA.
Malar J ; 15(1): 369, 2016 07 19.
Article in En | MEDLINE | ID: mdl-27430311
ABSTRACT

BACKGROUND:

Severe malaria has a case fatality rate of 10-20 %; however, few studies have addressed the quality of severe malaria case management. This study evaluated the diagnostic and treatment practices of malaria patients admitted to inpatient health facilities (HF) in Malawi.

METHODS:

In July-August 2012, a nationwide, cross-sectional survey of severe malaria management was conducted in 36 HFs selected with equal probability from all eligible public sector HFs in Malawi. Patient records from all admissions during October 2011 and April 2012 (low and high season, respectively) were screened for an admission diagnosis of malaria or prescription of any anti-malarial. Eligible records were stratified by age (< 5 or ≥ 5 years). A maximum of eight records was randomly selected within each age and month stratum. Severe malaria was defined by admission diagnosis or documentation of at least one sign or symptom of severe malaria. Treatment with intravenous (IV) quinine or artesunate was considered correct. Patients without documentation of severe malaria were analysed as uncomplicated malaria patients; treatment with an artemisinin-based combination therapy (ACT) or oral quinine based on malaria test results was considered correct. All analyses accounted for HF level clustering and sampling weights.

RESULTS:

The analysis included 906 records from 35 HFs. Among these, 42 % (95 % confidence interval [CI] 35-49) had a severe malaria admission diagnosis and 50 % (95 % CI 44-57) had at least one severe malaria sign or symptom documented. Severe malaria patients defined by admission diagnosis (93, 95 % CI 86-99) were more likely to be treated correctly compared to patients defined by a severe sign (82, 95 % CI 75-89) (p < 0.0001). Among uncomplicated malaria patients, 26 % (95 % CI 18-35) were correctly treated and 53 % (95 % CI 42-64) were adequately treated with IV quinine alone or in combination with an ACT or oral quinine.

CONCLUSIONS:

A majority of patients diagnosed with severe malaria received the recommended IV therapy in accordance with national treatment guidelines. However, the inconsistencies between diagnosis of severe malaria and documentation of severe signs and symptoms highlight the need to improve healthcare worker recognition and documentation of severe signs and symptoms.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Quinine / Disease Management / Guideline Adherence / Artemisinins / Malaria / Antimalarials Type of study: Diagnostic_studies / Guideline / Observational_studies / Prevalence_studies / Qualitative_research / Risk_factors_studies Limits: Adolescent / Adult / Child, preschool / Female / Humans / Male Country/Region as subject: Africa Language: En Journal: Malar J Journal subject: MEDICINA TROPICAL Year: 2016 Document type: Article Affiliation country: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Quinine / Disease Management / Guideline Adherence / Artemisinins / Malaria / Antimalarials Type of study: Diagnostic_studies / Guideline / Observational_studies / Prevalence_studies / Qualitative_research / Risk_factors_studies Limits: Adolescent / Adult / Child, preschool / Female / Humans / Male Country/Region as subject: Africa Language: En Journal: Malar J Journal subject: MEDICINA TROPICAL Year: 2016 Document type: Article Affiliation country: United States