Treatment of African children with severe malaria - towards evidence-informed clinical practice using GRADE

Malaria Journal

Review

Nyokabi Musila¹  Newton Opiyo¹  Mike English² 

[1] Child and Newborn Health Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, PO Box 43640 - 00100, Nairobi, Kenya;Child and Newborn Health Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, PO Box 43640 - 00100, Nairobi, Kenya;Department of Paediatrics, John Radcliffe Hospital, University of Oxford, Oxford, UK;

关键词: Malaria;    Quinine;    Severe Malaria;    Weighted Mean Difference;    Artesunate;   

DOI  :  10.1186/1475-2875-10-201

 received in 2011-01-18, accepted in 2011-07-21,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundSevere malaria is a major contributor of deaths in African children up to five years of age. One valuable tool to support health workers in the management of diseases is clinical practice guidelines (CPGs) developed using robust methods. A critical assessment of the World Health Organization (WHO) and Kenyan paediatric malaria treatment guidelines with quinine was undertaken, with a focus on the quality of the evidence and transparency of the shift from evidence to recommendations.MethodsSystematic reviews of the literature were conducted using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool to appraise included studies. The findings were used to evaluate the WHO and Kenyan recommendations for the management of severe childhood malaria.ResultsThe WHO 2010 malaria guidance on severe malaria in children, which informed the Kenyan guidelines, only evaluated the evidence on one topic on paediatric care using the GRADE tool. Using the GRADE tool, this work explicitly demonstrated that despite the established use of quinine in the management of paediatric cases of severe malaria for decades, low or very low quality evidence of important outcomes, but not critical outcomes such as mortality, have informed national and international guidance on the paediatric quinine dosing, route of administration and adverse effects.ConclusionsDespite the foreseeable shift to artesunate as the primary drug for treatment of severe childhood malaria, the findings reported here reflect that the particulars of quinine therapeutics for the management of severe malaria in African children have historically been a neglected research priority. This work supports the application of the GRADE tool to make transparent recommendations and to inform advocacy efforts for a greater research focus in priority areas in paediatric care in Africa and other low-income settings.

【 授权许可】

CC BY   
© Musila et al; licensee BioMed Central Ltd. 2011