Anti‑malarial prescription practices among children admitted to six public hospitals in Uganda from 2011 to 2013
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Date
2015
Journal Title
Journal ISSN
Volume Title
Publisher
Malaria journal
Abstract
In 2011, Uganda’s Ministry of Health switched policy from presumptive treatment of malaria to recommending
parasitological diagnosis prior to treatment, resulting in an expansion of diagnostic services at all levels of
public health facilities including hospitals. Despite this change, anti-malarial drugs are often prescribed even when
test results are negative. Presented is data on anti-malarial prescription practices among hospitalized children who
underwent diagnostic testing after adoption of new treatment guidelines.
Methods: Anti-malarial prescription practices were collected as part of an inpatient malaria surveillance program
generating high quality data among children admitted for any reason at government hospitals in six districts. A
standardized medical record form was used to collect detailed patient information including presenting symptoms
and signs, laboratory test results, admission and final diagnoses, treatments administered, and final outcome upon
discharge.
Results: Between July 2011 and December 2013, 58,095 children were admitted to the six hospitals (hospital range
3294–20,426).A total of 56,282 (96.9 %) patients were tested for malaria, of which 26,072 (46.3 %) tested positive
(hospital range 5.9–57.3 %). Among those testing positive, only 84 (0.3 %) were first tested after admission and 295 of
30,389 (1.0 %) patients who tested negative at admission later tested positive. Of 30,210 children with only negative
test results, 11,977 (39.6 %) were prescribed an anti-malarial (hospital range 14.5–53.6 %). The proportion of children
with a negative test result who were prescribed an anti-malarial fluctuated over time and did not show a significant
trend at any site with the exception of one hospital where a steady decline was observed. Among those with only
negative test results, children 6–12 months of age (aOR 3.78; p < 0.001) and those greater than 12 months of age
(aOR 4.89; p < 0.001) were more likely to be prescribed an anti-malarial compared to children less than 6 months of
age. Children with findings suggestive of severe malaria were also more likely to be prescribed an anti-malarial after a
negative test result (aOR 1.98; p < 0.001).
Conclusions: Despite high testing rates for malaria at all sites, prescription of anti-malarials to patients with negative
test results remained high, with the exception of one site where a steady decline occurred.
Description
Keywords
Anti-malarial, Treatment, Children, Hospitals, Uganda
Citation
Sserwanga, A., Sears, D., Kapella, B. K., Kigozi, R., Rubahika, D., Staedke, S. G., ... & Mpimbaza, A. (2015). Anti-malarial prescription practices among children admitted to six public hospitals in Uganda from 2011 to 2013. Malaria journal, 14(1), 1-10. DOI 10.1186/s12936-015-0851-8