The Influence of pre-hospital treatment of fever on severity of malaria among children 6-59 months presenting at Mulago Hospital: A case-control study

Abstract

Introduction: Delivery of prompt and adequate treatment for malaria at the community level remains a strategy to reduce the burden of malaria in sub-Saharan Africa. As a result of this many patients with suspected malaria take anti-malaria medicines in the communities with or without prescription before visiting hospitals/health units. The effect of use of this pre-hospital medication on malaria presentation in the hospital is poorly described.

Objectives: The aims of this study were to determine the influence of pre-hospital treatment of fever on malaria severity among children 6-59 months presenting to Mulago hospital and the factors associated with pre-hospital treatment of fever.

Methodology: We carried out a case-control study at Acute Care Unit Mulago National referral, among children aged between 6-59 months presenting with malaria. We enrolled 100 cases (Children with severe malaria) and 105 controls (children with un-complicated malaria) that were assessed for pre-hospital treatment of fever. Chi square test was used to compute the odds of using pre-hospital treatment among the cases and controls. Multiple logistic regressions were used to determine the factors associated with pre-hospital treatment of fever. Variables with a p-value of ≤0.05 at the multivariate analysis were considered statistically significant.

Results: Overall the level of pre-hospital treatment of fever was 147/205 (71.7%). Of these, 91/147(44.4%) used anti-malaria medicines. 35/83 (42.2%) received medicines from the clinics and 27/83 (32.5%) from hospitals. Receipt of adequate anti-malaria doses was reported in 41/91(45.1%) of patients. Cases had significantly higher Odds of having used pre-hospital medication compared to controls with an odds ratio of 2.52 (95% CI=1.33-4.77 and p-value of 0.004). Use of anti-malaria medicines was also higher among the cases at 58/100 (58%) as compared to controls at 33/105(31.4%) with an odds ratio of 3.01 (95%CI of 1.70-5.34 and p-value of <0.001). But this relationship was not true when only those taking adequate anti-malarial doses were considered with an OR of 1.24(95%CI of 0.53-2.93 and p-value of 0.620). Having fever for more than three days was significantly associated with use of pre-hospital treatment of fever with an OR of 2.46 (95% CI=1.28-4.73 and a p-value of 0.007). Other factors like age, sex, distance, mother’s level of education and occupation were not significantly associated with use of pre-hospital medication.

Conclusions: Patients with severe malaria were more likely to have taken pre-hospital medications compared to those with uncomplicated malaria. Delay in presentation to Mulago National Referral Hospital of more than three days of fever was associated with use of pre-hospital medication.

Recommendations: There is a need for community sensitization on dangers of using inadequate doses of anti-malaria medicines. Further studies need to be conducted to establish the effect of pre-hospital anti-malaria medicine use on disease progression.