Prescription patterns and compliance with World Health Organization recommendations for the management of uncomplicated and severe malaria: A prospective, real-world study in sub-Saharan Africa.

Publisher: BioMed Central Country of Publication: England NLM ID: 101139802 Publication Model: Electronic Cited Medium: Internet ISSN: 1475-2875 (Electronic) Linking ISSN: 14752875 NLM ISO Abbreviation: Malar J Subsets: MEDLINE

Original Publication: London : BioMed Central, [2002-

Antimalarials* ; Malaria*/diagnosis ; Malaria*/drug therapy ; Malaria, Falciparum*/drug therapy; Humans ; Infant, Newborn ; Artemether, Lumefantrine Drug Combination/therapeutic use ; Prospective Studies ; Artemether/therapeutic use ; Prescriptions ; World Health Organization ; Tanzania ; Drug Combinations

Background: This study aimed to evaluate the gap between guidelines and local clinical practice for diagnosis and treatment of uncomplicated and severe malaria, the patient characteristics, diagnostic approach, treatment, and compliance to standard guideline recommendations.
Methods: This was a multicentre, observational study conducted between October 2020 and March 2021 in which patients of all ages with symptoms suggestive of malaria and who visited a healthcare facility were prospectively enrolled in six countries in sub-Saharan Africa (The Democratic Republic of the Congo, Mozambique, Nigeria, Rwanda, The United Republic of Tanzania, and Zambia).
Results: Of 1001 enrolled patients, 735 (73.4%) patients had confirmed malaria (based on overall judgment by investigator) at baseline (uncomplicated malaria: 598 [81.4%] and severe malaria: 137 [18.6%]). Of the confirmed malaria patients, 533 (72.5%) were administered a malaria rapid diagnostic test. The median age of patients was 11 years (range: 2 weeks-91 years) with more patients coming from rural (44.9%) than urban (30.6%) or suburban areas (24.5%). At the community level, 57.8% of patients sought advice or received treatment for malaria and 56.9% of patients took one or more drugs for their illness before coming to the study site. In terms of early access to care, 44.1% of patients came to the study site for initial visit ≥ 48 h after symptom onset. In patients with uncomplicated malaria, the most prescribed treatments were artemisinin-based combination therapy (ACT; n = 564 [94.3%]), primarily using artemether-lumefantrine (82.3%), in line with the World Health Organization (WHO) treatment guidelines. In addition, these patients received antipyretics (85.6%) and antibiotics (42.0%). However, in those with severe malaria, only 66 (48.2%) patients received parenteral treatment followed by oral ACT as per WHO guidelines, whereas 62 (45.3%) received parenteral treatment only. After receiving ambulatory care, 88.6% of patients with uncomplicated malaria were discharged and 83.2% of patients with severe malaria were discharged after hospitalization. One patient with uncomplicated malaria having multiple co-morbidities and three patients with severe malaria died.
Conclusions: The findings of this study suggest that the prescribed treatment in most patients with uncomplicated malaria, but not of those with severe malaria, was in alignment with the WHO recommended guidelines.
(© 2023. The Author(s).)

Malar J. 2021 Jan 21;20(1):56. (PMID: 33478507)
Am J Trop Med Hyg. 2019 Apr;100(4):842-845. (PMID: 30719965)
Emerg Infect Dis. 2022 Mar;28(3):608-616. (PMID: 35201739)
Malar J. 2015 Aug 27;14:331. (PMID: 26306395)
Public Health Action. 2018 Apr 25;8(Suppl 1):S3-S7. (PMID: 29713586)
Sci Rep. 2021 Nov 26;11(1):22979. (PMID: 34837020)
Trop Med Int Health. 2014 Sep;19 Suppl 1:7-131. (PMID: 25214480)
Malar J. 2020 Nov 4;19(1):391. (PMID: 33148255)
J Clin Microbiol. 2019 Aug 26;57(9):. (PMID: 31270184)
Malar J. 2022 Jun 3;21(1):164. (PMID: 35658968)
Trends Parasitol. 2017 Feb;33(2):128-140. (PMID: 27939610)
Malar J. 2022 Apr 19;21(1):126. (PMID: 35439987)
PLoS One. 2011 Mar 01;6(3):e17053. (PMID: 21390301)
Malar J. 2016 Oct 18;15(1):506. (PMID: 27756388)
Malar J. 2019 Feb 8;18(1):36. (PMID: 30736864)
BMC Med. 2022 Oct 11;20(1):343. (PMID: 36217159)
Emerg Infect Dis. 2021 Feb;27(2):471-479. (PMID: 33496220)
J Pharm Policy Pract. 2014 Nov 14;7(1):15. (PMID: 25838917)
BMC Health Serv Res. 2019 Dec 4;19(1):932. (PMID: 31801533)
Trop Med Int Health. 2022 Feb;27(2):129-136. (PMID: 34978744)
Expert Rev Anti Infect Ther. 2022 Mar;20(3):353-372. (PMID: 34348573)
Trop Med Infect Dis. 2022 Jul 18;7(7):. (PMID: 35878149)

Keywords: Compliance; Diagnosis; Malaria; Prescription; Recommendations; Treatment

0 (Antimalarials)
0 (Artemether, Lumefantrine Drug Combination)
C7D6T3H22J (Artemether)
0 (Drug Combinations)

Date Created: 20230725 Date Completed: 20230727 Latest Revision: 20230729

20230729

PMC10367305

10.1186/s12936-023-04650-y

37491295