Qualitative study of presumptive treatment of childhood malaria in third tier tertiary hospitals in southeast Nigeria: a focus group and in-depth studyReportar como inadecuado

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Malaria Journal

, 12:436

First Online: 01 December 2013Received: 24 May 2013Accepted: 25 November 2013


BackgroundPresumptive treatment of childhood-malaria PTCM is common in Nigeria. Delayed laboratory result is blamed, with little attention on patients’ and providers’ roles. This study aimed to determine patient, provider and laboratory attributes that sustain PTCM in Nigeria.

MethodsData collection was from focus-group discussions for parents-guardians, and in-depth interviews involving providers and laboratory scientists in two tertiary hospitals.

ResultsAll parents-guardians agreed to a malaria test. Majority accepted to come back later for full treatment, provided that some treatment was commenced. Majority affirmed that their interests are on their children’s improvement.

The providers practice presumptive treatment of childhood malaria, for the following reasons: 1 malaria is endemic and should be suspected and treated; 2 microscopy takes two days to be available and parents want immediate treatment for their children, thus delay may lead to self-medication; 3 relying on results for decision to treat creates an impression of incompetence; 4 rapid diagnostic test kits RDTs are not available in the consulting rooms and there is doubt about their reliability; 5 patients have already wasted time before being reviewed, so wasting more time on investigation is not advisable; 6 withhold of malaria treatment may be feasible in suspected uncomplicated malaria, but if severe, then anti-malarial treatment has to start immediately.

Interviews of laboratory scientists showed that 1 malaria microscopy test cannot be urgent; it is done in batches and takes 24 hours to be ready; 2 a request of malaria test with other investigations on the same form, contributes to the delay; 3 RDTs are unavailable in the facilities.

ConclusionsProvision of RDTs is the only feasible means to treatment of confirmed malaria at the time healthcare providers review a patient on day zero. In facilities that depend on microscopy; a common practice in resource poor countries, healthcare providers can depend on parental willingness to return later for full medication, to commence adjunctive care with antipyretics and multivitamins for uncomplicated malaria. In complicated malaria, supportive care - intravenous fluids, blood transfusion, oxygen therapy - can be commenced while awaiting the inclusion of anti-malarial drugs when the diagnosis of malaria is confirmed.

KeywordsPresumptive treatment Childhood malaria Tertiary hospitals Nigeria AbbreviationsACTArtemisinin-based combination therapy

FGDFocus group discussion

IDIIn-depth interview

PTCMPresumptive treatment of childhood malaria

RBMRoll back malaria

RDTRapid diagnostic test kits

WHOWorld health organization.

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Autor: Maduka D Ughasoro - Chinedu C Okoli - Benjamin SC Uzochukwu

Fuente: https://link.springer.com/

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