Healthcare worker treatment practices for severe malaria for children Aged 6 Months to 12 years at Mulago National Referral Hospital, Uganda

Abstract

Background: Malaria remains an important public health concern, it is estimated that 3.2 billion people are at of risk contracting malaria annually. In Uganda, malaria is among the leading causes of illness and death. Malaria case management, consisting of early diagnosis and prompt effective treatment, remains a vital component of malaria control and elimination strategies. In 2022 World Health Organization/Ministry of Health updated malaria treatment guidelines recommending 1. Test and treat approach, 2. Use Malaria RDTs if quality-assured malaria microscopy is not readily available,3. Parenteral artesunate use for severe malaria and treatment is completed with a full course of Dihydroartemisinin Piperaquine (DP) then monthly for 3 months as chemoprevention. As to if this is followed is unknown since no study has been carried out since the changes. This study seeks to determine health care worker severe malaria treatment factors and influencing factors at Mulago National Referral Hospital. Objective To determine the treatment practices among health care workers in managing children of age 6 months to 12 years with severe malaria and the influencing factors at Mulago National Referral Hospital, Uganda. Methods: This was a parallel convergent mixed methods cross-sectional study that recruited children 6 months to 12 years with a diagnosis of with severe malaria admitted to the pediatric wards in Mulago National Referral Hospital. Quantitative data was collected using a structured questionnaire by interviewing patient care givers and a data abstraction tool was used to collect data from patient files from admission until discharge. This data was exported to STATA 17.0 for analysis. Eleven in-depth interviews(IDIs) were conducted among the health care workers to obtain information on the influencing factors to treatment practices. The transcripts were thematically analyzed using Nvivo software. Results: A total of 204 children with severe malaria were recruited. Majority of the children were males 128 (62.7%), median age was 4 years. A total of 196 (96.1%) were treated with iv artesunate and the rest of the patients were treated with both iv artesunate and iv quinine, after which oral antimalarials were prescribed to 195 (96.4%) of the patients. A total of 190 (97.4%) received Dihydroartemisinin/ Piperaquine (DP), and 5(2.6%) artemether lumefantrine as oral continuation dose and 181 (88.7%) received an explanation on how to take them. Post discharge chemoprevention at discharge was provided to 181 (88.7%) of the patients with 163(90%) receiving DP. Availability of diagnostic tools and equipment, availability of antimalarial drugs, patient’s age and weight, training on malaria treatment guidelines were identified as some of the factors that influenced malaria treatment practices. Conclusion: This study indicates there was a high adherence to the Ministry of Health (MOH) and World Health Organization (WHO) guidelines for management of children with severe malaria admitted in the hospital. Availability of drugs and diagnostic tools, and training of health care workers on current guidelines greatly influenced better treatment practices.