Treatment and outcomes of children with negative malaria smears at Aduku, Kihihi and Nagongera health centres.

Abstract

INTRODUCTION: The Uganda Ministry of Health guidelines recommend that all patients with fever without evidence of other diseases be treated for malaria regardless of smear results. With the introduction of Artemisinin-based combined therapy, this may be inappropriate due to the high relative costs and unknown adverse effects. This study was designed to investigate the clinical management and outcomes of children who present with fever and blood smears are negative for malaria at government health centres. METHODS: A cross sectional study was conducted at three health centres IVs; kihihi, Nagongera and Aduku (Uganda). Children aged 6 months to 10 years with fever and negative blood smears for malaria were included in the study. All participants were managed according to the standard of care by clinicians at the health centre. Information of diagnosis and treatment recommendations was collected in exit interviews. A repeat blood smear was done on day 3 to evaluate development of patient parasitemia and caretakers’ report of symptom resolution was collected on day 7. RESULTS: Of the 430 children enrolled, 199(46.2%) had antimalarials prescribed. Of the 414 children who returned for the day 3 visit, 50 (12.1%) had a positive smear. Children at Nagongera were more likely to have antimalarials prescribed than children kihihi health centre. (OR 29.2 95% C1 21.4- 39.6). Children at Aduku were more likely to have antimalarials prescribed than children at kihihi health centre (OR 2.3 95% C12.1-2.5). There was nosignificant difference in the day 3 smear between children who received an antimalarial and those who did not (OR 1.3, 95%C1 0.7-2.3). Of the 408 children who returned for the day 7 visit, 389 (95.3%) had resolution of symptoms. There was no significant difference in the resolution of fever by day 7 between children who received an antimalarial and those who ddnot (OR 1.4, 95%C1 0.9-2.2). CONCLUSION AND RECOMMENDATIONS: Antimalarials who prescribed for nearly half of the symptomatic children with negative blood smears, but we did not observe any parasitological or clinical benefit to this management strategy. In order to reduce the costs of treating malaria in Uganda, Clinicians need not prescribe antimalarials to patients with negative blood smear. However, a day 3 follow-up visit is recommended for further assessment and management. In order to reduce on proportion smear negative children receiving antimalarials, guidelines, job aids, training and supervision should be done for the health workers.