![]() ![]() Also, advancements have been made in the area of malaria diagnosis with the introduction of simple and easy to apply malaria RDT kits. where they documented positive malaria parasitaemia of 29.2% amongst children with history of fever in a tertiary clinic. This was supported by a report by Tagbo et al. Studies have shown a decline in the burden of malaria in these endemic areas, with a concomitant reduction in the proportions of fever that can be attributed to malaria. It is 13 years since the introduction of RBM programmes in sub-Saharan Africa. Studies have shown that if 70% or more of fever cases are malaria fever, presumptive treatment is more cost-effective than prior microscopy or rapid diagnostic test (RDT) when artemisinin-based combination therapy is the anti-malarial in usage. Furthermore, it was argued that since the prevalence of malaria was high in most sub-Saharan regions, and first tier facilities are amongst the first source of care for the patients, presumptive treatment will be cost-effective if practiced there. Another reason for this is the anticipated high mortality that will occur especially in children if anti-malarial therapy is delayed for malaria test results to be available, the problem of lack of laboratory support is expected more in the primary health care facilities. Due to high prevalence of malaria in these areas, and its associated high mortality in children, it was advocated that an anti-malarial can be given based on the presence of fever. One of its strategies is early diagnosis and treatment of malaria. In April 2000, the Roll Back Malaria (RBM) programme was launched in Abuja, Nigeria with the sole aim of reducing the burden of malaria in sub-Saharan Africa. 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. 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. Provision of RDTs is the only feasible means to treatment of confirmed malaria at the time healthcare providers review a patient on day zero. 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. 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. Majority affirmed that their interests are on their children’s improvement. Majority accepted to come back later for full treatment, provided that some treatment was commenced. ResultsĪll parents/guardians agreed to a malaria test. Methodsĭata collection was from focus-group discussions for parents/guardians, and in-depth interviews involving providers and laboratory scientists in two tertiary hospitals. This study aimed to determine patient, provider and laboratory attributes that sustain PTCM in Nigeria. Delayed laboratory result is blamed, with little attention on patients’ and providers’ roles. ![]() Presumptive treatment of childhood-malaria (PTCM) is common in Nigeria.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |