Antimalarial Prescription Practices for Children with Negative Microscopy Results for Malaria Parasites admitted at the Moi Teaching and Referral Hospital, Kenya

Abstract

Background: The burden of malaria is declining globally including Kenya, however a high number of patients continue to be treated for malaria in our set up. Malaria parasite resistance, especially of Plasmodium falciparum, to artemisinin drugs can reverse these gains. This scenario can be prevented by adopting correct diagnosis and appropriate treatment. Adherence to test results is cost effective, prevents resistance and has been shown to save lives. The study sought to evaluate clinicians’ adherence to negative malaria test results in a referral hospital. Objective: To determine the clinicians’ antimalarial prescription practices in the management of children with negative microscopy results. Methodology: A prospective observational study was carried out on children, aged 1 month to 14 years, admitted with a negative microscopy results for malaria parasites at the general paediatric wards of Moi Teaching and Referral Hospital, Kenya. Data was collected from December 2012 to June 2013 using a structured questionnaire. The primary outcome was antimalarial prescription, while secondary outcomes were: antibiotic use, duration of stay in hospital, discharge home, or death. Data was analysed using STATA version 10 software at 95% level of confidence. Descriptive statistics were generated for continuous and categorical data. Chi-square test, Kruskal-Wallis test and logistical regression were used to test for associations among variables. Results: A total of 250 participants were enrolled. The median age was 19.5 months (IQR10, 36) with 150 (60%) being male. Forty one (16%) of the participants had travelled to malaria endemic regions in the preceding 4 weeks while 30 (12%) had used antimalarial prior to admission. Those treated with antimalarial with negative microscopy results were 34 (13.6%). History of travel, increased sleepiness, convulsions, headache, having been on antimalarial prior to presenting to hospital, pallor and abnormal central nervous examination findings were associated with antimalarial prescription despite negative test results. Presence of cough was associated with reduced likelihood of treatment (P value <0.05). Increased sleepiness, history of headache and prior antimalarial use were independent clinical characteristics associated with treatment. Antibiotics were concurrently used with antimalarial in 30 (88.2%) of the patients with odds ratio of 1.212 (95%CI 0.40-3.68). The mean duration of hospital stay was 3.53 days for those on anti- malarial versus 3.75 days for those not treated which was not statistically different(P =0.61). One participant died in the group not on antimalarial. Conclusion: There was a substantial proportion (13.6%) of children treated for malaria with negative microscopy results. Increased sleepiness, headache and having been on antimalarial prior to hospitalization, influenced the treatment. No differences were noted in duration of hospital stay, antibiotics prescription, discharge home or death in comparison with the group not treated. A similar study in the outpatient set up is recommended.