Malaria Care in Infants Aged under Six Months in Uganda: An Area of Unmet Needs!
Loading...
Date
2015
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS One
Abstract
Little information exists on malaria burden, artemisinin-based combination therapy (ACT)
use, and malaria care provided to infants under six months of age. The perception that malaria
may be rare in this age group has led to lack of clinical trials and evidence-based treatment
guidelines. The objective of this study was to identify malaria parasitemia positivity
rate (MPPR) among patients under six months, and practices and predictors of malaria diagnosis
and treatment in this population.
Methods
Cross-sectional data collected from October 2010 to September 2011 on 25,997 individual
outpatients aged <6 months from 36 health facilities across Uganda were analysed.
Findings
Malaria was suspected in 18,415 (70.8%) patients, of whom 7,785 (42.3%) were tested for
malaria. Of those tested, the MPPR was 36.1%, with 63.9%testing negative, of which 1,545
(31.1%) were prescribed an antimalarial. Among children <5kgs, off-label prescription of
ACT was high (104/285, 36.5%). Younger age (1-6 days, aOR=0.47, p=0.01; 7-31 days,
aOR=0.43, p<0.001; and 1-2 months, aOR=0.61, p<0.001), pneumonia (aOR=0.78,
p=0.01) or cough/cold (aOR=0.65, p<0.001) diagnosis, and fever (aOR=0.56, p=0.01) reduced
the odds of receiving a malaria test. Fever (aOR=2.22, p<0.001), anemia diagnosis
(aOR=3.51, p=0.01), consulting midwives (aOR=3.58, p=0.04) and other less skilled providers
(aOR=4.75, p<0.001) relative to medical officers, consulting at hospitals (aOR=3.31,
p=0.03), visiting health facilities in a medium-high malaria transmission area (aOR=2.20,
p<0.001), and visiting during antimalarial (aOR=1.82, p=0.04) or antibiotic (aOR=2.23,
p=0.04) shortages increased the odds of prescribing an antimalarial despite a negative malaria
test result. Conclusions
We found high malaria suspicion but low testing rates in outpatient children aged <6
months. Among those tested, MPPR was high. Despite a negative malaria test result, many
infants were prescribed antimalarials. Off-label ACT prescription was common in children
weighing <5kgs. Evidence-based malaria guidelines for infants weighing <5 kilograms and
aged <6 months are urgently needed.
Description
Keywords
Malaria Care, Infants, Unmet Needs
Citation
Mbonye MK, Burnett SM, Naikoba S, Colebunders R, Wouters K, Weaver MR, et al. (2015) Malaria Care in Infants Aged under Six Months in Uganda: An Area of Unmet Needs!. PLoS ONE 10(4): e0123283. doi:10.1371/journal.pone.0123283