Management of severe malaria in children under 5 years of age in private and public health facilities in Cross River State, southeastern Nigeria: an audit of current practices

Friday Odey,^1,2 Ekpereonne Esu,^1,3 Emmanuel Effa,^1,4 Ekong Udoh,^1,2 Olabisi Oduwole,¹ Moriam Chibuzor,¹ Angela Oyo-Ita,^1,5 Martin Meremikwu<sup>1,2

1</sup>Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria; ²Department of Pediatrics, College of Medical Sciences, University of Calabar, Calabar, Nigeria; ³Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria; ⁴Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria; ⁵Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria

Purpose: The policy for the treatment of severe malaria in Nigeria was revised in June 2011 to parenteral artesunate followed by a full course of artemisinin-based combination therapy. This audit assesses how well health care providers in public and private facilities comply with the current national treatment guidelines.
Patients and methods: A clinical audit was conducted on the patient case records of children below 5 years of age who were managed for severe malaria in Cross River State, southeastern Nigeria. Multi-staged sampling was used to select the secondary health facilities for the exercise. The audit was conducted between January 2012 and March 2012.
Results: A total of 119 cases of severe malaria in children under 5 were assessed in three public and 12 private facilities. Light microscopy was more frequently used in confirming the diagnosis of malaria than rapid diagnostic tests. Malaria smear was more commonly done in private than public facilities (P = 0.02). A majority of patients (81%) received parenteral antimalaria drugs, with intramuscular artemether (60.4%) being the most commonly prescribed. Only 58% and 47% of cases received correct doses of parenteral drugs in public and private facilities, respectively. More public facilities prescribed oral artemisinin-based combination therapy after discontinuation of parenteral drugs (P = 0.02).
Conclusion: There is need to improve the case management of severe malaria in both public and private facilities in the state. Health workers should be regularly updated on the amended guidelines for the management of severe malaria. We recommend the provision of rapid diagnostic test kits to health facilities.

Keywords: severe malaria, case management, clinical audit, resource-limited setting