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

Malaria Journal

Research

Maduka D Ughasoro¹  Chinedu C Okoli²  Benjamin SC Uzochukwu³ 

[1] Department of Paediatrics, University of Nigeria Enugu Campus, Enugu, Nigeria;Health Policy Research Group, University of Nigeria Teaching Hospital, Enugu, Nigeria;Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria;Health Policy Research Group, University of Nigeria Teaching Hospital, Enugu, Nigeria;Department of Community Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria;

关键词: Presumptive treatment;    Childhood malaria;    Tertiary hospitals;    Nigeria;   

DOI  :  10.1186/1475-2875-12-436

 received in 2013-05-24, accepted in 2013-11-25,  发布年份 2013

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© Ughasoro et al.; licensee BioMed Central Ltd. 2013