Failures in the case management of children with uncomplicated malaria in Bata district of Equatorial Guinea and associated factors

Suárez-Sánchez, Pablo; García, Belén; Nzang, Jesús; Ncogo, Policarpo; Riloha, Matilde; Berzosa, Pedro; Benito, Agustín; Romay‐Barja, María

doi:10.1371/journal.pone.0220789

Cited by 4 publications

(11 citation statements)

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“…The same reasons and preference for AL compared to ASAQ has been described in many countries in the region [ 25 , 26 ]. The use of injectable AM as a treatment for uncomplicated malaria has only been described in Sudan [ 27 , 28 ] and Equatorial Guinea [ 15 , 29 ]. This use of artemisinin monotherapy to treat uncomplicated malaria can contribute to the emergence of resistance to ACT and lead to treatment failure [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Questions about their sociodemographic characteristics, the biological cycle of malaria parasites, malaria treatment practices, the recommendations given by the NMTG and resistance to anti-malarial drugs were included in the questionnaire. Details of the survey have been described previously [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

“…The use of oral artemisinin monotherapy was forbidden in Equatorial Guinea in 2014 [ 14 ]. Unfortunately, 9 years after the introduction of ASAQ therapy in Equatorial Guinea, compliance with the first-line treatment seems to be very poor in the Bata District [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Knowledge and practices regarding malaria and the National Treatment Guidelines among public health workers in Equatorial Guinea

Blanco

Suárez-Sánchez

García

et al. 2021

Malar J

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Background In 2018, an estimated 228 million cases of malaria occurred worldwide. Countries are far from having achieved reasonable levels of national protocol compliance among health workers. Lack of awareness of treatment protocols and treatment resistance by prescribers threatens to undermine progress when it comes to reducing the prevalence of this disease. This study sought to evaluate the degree of knowledge and practices regarding malaria diagnosis and treatment amongst prescribers working at the public health facilities of Bata, Equatorial Guinea. Methods A cross-sectional survey was conducted in October-December 2017 amongst all public health professionals who attended patients under the age of 15 years, with suspected malaria in the Bata District of Equatorial Guinea. Practitioners were asked about their practices and knowledge of malaria and the National Malaria Treatment Guidelines. A bivariate analysis and a logistic regression model were used to determine factors associated with their knowledge. Results Among the 44 practitioners interviewed, 59.1% worked at a Health Centre and 40.9% at the District Hospital of Bata. Important differences in knowledge and practices between hospital and health centre workers were found. Clinical diagnosis was more frequently by practitioners at the health centres (p = 0.059), while microscopy confirmation was more frequent at regional hospital (100%). Intramuscular artemether was the anti-malarial most administrated at the health centres (50.0%), while artemether-lumefantrine was the treatment most used at the regional hospital (66.7%). Most practitioners working at public health facilities (63.6%) have a low level of knowledge regarding the National Malaria Treatment Guidelines. While knowledge regarding malaria, the National Malaria Treatment Guidelines and treatment resistances is low, it was higher amongst hospital workers than amongst practitioners at health centres. Conclusions It is essential to reinforce practitioners’ knowledge, treatment and diagnosis practices and use of the National Malaria Treatment Guidelines in order to improve malaria case management and disease control in the region. A specific malaria training programme ensuring ongoing updates training is necessary in order to ensure that greater experience does not entail obsolete knowledge and, consequently, inadequate diagnosis and treatment practices.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Knowledge and practices regarding malaria and the National Treatment Guidelines among public health workers in Equatorial Guinea

Blanco

Suárez-Sánchez

García

et al. 2021

Malar J

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“…Two studies in Sudan identified relatively high proportions of children with uncomplicated malaria receiving injectable quinine [36], but with receipt of injectables more frequent in those over five than under 5 years [37]. Monotherapy was also more common in those aged older than five in studies in Nigeria [15] and Equatorial Guinea [18]. When monotherapy is prescribed for severe malaria, parenteral drugs should be given for a minimum of 24 h and always followed by a full oral course of ACT [4,38].…”

Section: Discussionmentioning

confidence: 99%

“…Limitations in case management identified by previous studies included failure to perform diagnostic testing on all suspected malaria cases [13][14][15], prescription of antimalarial drugs for test negative patients [14,16,17], or ACT not being prescribed to patients with confirmed malaria [18,19]. Additional shortcomings in other settings include 'poly-pharmacy' whereby multiple antimalarials are given at once, incorrect dose prescription [13,20], and lack of referral/admission or pre-referral treatment for severe malaria [21].…”

Section: Introductionmentioning

confidence: 99%

Management of uncomplicated malaria among children under five years at public and private sector facilities in Mali

et al. 2020

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Background Prompt and effective malaria diagnosis and treatment is a cornerstone of malaria control. Case management guidelines recommend confirmatory testing of suspected malaria cases, then prescription of specific drugs for uncomplicated malaria and for severe malaria. This study aims to describe case management practices for children aged 1–59 months seeking treatment with current or recent fever from public and private, rural and urban health providers in Mali. Methods Data were collected at sites in Sikasso Region and Bamako. Health workers recorded key information from the consultation including malaria diagnostic testing and result, their final diagnosis, and all drugs prescribed. Children with signs of severe diseases were ineligible. Consultations were not independently observed. Appropriate case management was defined as both 1) tested for malaria using rapid diagnostic test or microscopy, and 2) receiving artemisinin combination therapy (ACT) and no other antimalarials if test-positive, or receiving no antimalarials if test-negative. Results Of 1602 participating children, 23.7% were appropriately managed, ranging from 5.3% at public rural facilities to 48.4% at community health worker sites. The most common reason for ‘inappropriate’ management was lack of malaria diagnostic testing (50.4% of children). Among children with confirmed malaria, 50.8% received a non-ACT antimalarial (commonly artesunate injection or artemether), either alone or in combination with ACT. Of 215 test-negative children, 44.2% received an antimalarial drug, most commonly ACT. Prescription of multiple drugs was common: 21.7% of all children received more than one type of antimalarial, while 51.9% received an antibiotic and antimalarial. Inappropriate case management increased in children with increasing axillary temperatures and those seeking care over weekends. Conclusions Multiple limitations in management of febrile children under five were identified, including inconsistent use of confirmatory testing and apparent use of severe malaria drugs for uncomplicated malaria. While we cannot confirm the reasons for these shortcomings, there is a need to address the high use of non-ACT antimalarials in this context; to minimize potential for drug resistance, reduce unnecessary expense, and preserve life-saving treatment for severe malaria cases. These findings highlight the challenge of managing febrile illness in young children in a high transmission setting.

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How socioeconomic status affected the access to health facilities and malaria diagnosis in children under five years: findings from 19 sub-Saharan African countries

Liang

Cao

et al. 2023

Infect Dis Poverty

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Background Prompt and appropriate clinical management of malaria is critical for reducing the continued high burden of malaria among children under five years in sub-Saharan countries. However, more remains to be known about how a patient’s socioeconomic status (SES) would affect the access to diagnosis of malaria. Methods In this cross-sectional study using the Demographic and Health Survey and Malaria Indicators Survey, we pooled the data of 38,567 febrile under-five children in 2016–2018 from 19 sub-Saharan countries. Multivariable logistic regression was used to assess the associations between SES and two binary outcomes: the visit to a health facility and a blood test for fever. Stratified analyses were further conducted by the type of health facilities (public hospitals/public primary healthcare facilities/private hospitals/private primary healthcare facilities) for the latter outcome. Results Fifty-eight percent of the febrile children were taken to health facilities, among whom only 55% took blood tests. Compared to children from households in the highest wealth quintile, children in the lowest quintile were less likely to be taken to medical facilities [adjusted odds ratio (aOR) = 0.775, 95% confidence interval (CI): 0.675–0.889]. Parents with more than secondary education were more likely to seek care (aOR = 1.830, 95% CI: 1.561–2.145) and to have blood tests (aOR = 1.729, 95% CI: 1.436–2.082) for their febrile children than parents without formal education. The probabilities of receiving blood tests at public hospitals and public primary healthcare facilities stayed relatively high across parental education levels and wealth quintiles, while these probabilities remained the lowest at private primary healthcare facilities, ranging from 0.100 (95% CI: 0.074–0.127) to 0.139 (95% CI: 0.083–0.194) across parental education levels and from 0.104 (95% CI: 0.078–0.130) to 0.125 (95% CI: 0.090–0.160) across wealth quintiles. Conclusions Significant socioeconomic disparities existed both in the access to health facilities and laboratory diagnosis of malaria in children in sub-Saharan African countries. These disparities were particularly evident in the private sector. Universal health coverage needs to be further strengthened to make formal healthcare in general and the laboratory diagnosis of malaria more accessible and affordable. Graphical abstract

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Failures in the case management of children with uncomplicated malaria in Bata district of Equatorial Guinea and associated factors

Cited by 4 publications

References 33 publications

Knowledge and practices regarding malaria and the National Treatment Guidelines among public health workers in Equatorial Guinea

Knowledge and practices regarding malaria and the National Treatment Guidelines among public health workers in Equatorial Guinea

Management of uncomplicated malaria among children under five years at public and private sector facilities in Mali

How socioeconomic status affected the access to health facilities and malaria diagnosis in children under five years: findings from 19 sub-Saharan African countries

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