Assessment of use of national guidelines for malaria case management among paediatric resident doctors attending an update course in Benin City, Nigeria

Introduction: The National Malaria Guideline is a veritable tool for appropriate case management of malaria. Whether the pediatric residents who are the primary caregivers of children know and make use of this guideline in their routine practice is not yet assessed. Aim: The aim of the study is to assess the awareness of the Nigerian pediatric residents of the national guidelines for malaria case management (including antimalarial prescription for uncomplicated and severe malaria). Settings and Design: The descriptive study carried out during the 2017 National Postgraduate Medical College of Nigeria, Faculty of Paediatrics Update Course in Benin City. Subjects and Methods: Data were obtained using a self‑administered questionnaire which was given to all pediatric residents who participated at the update course and who had given written informed consent. Statistical Analysis Used: The statistical analysis was done using the Statistical Package for the Social Sciences version 16.0 (Inc., Chicago, Illinois, USA). Results: Of the 108 participants whose questionnaires were analyzed, 75.0% were Part 1 candidates and 25.0% Part 2 candidates; mean age 34.0 ± 4.5 years (range 26–51 years) and 42 (39.0%) males while 66 (61.0%) were female. Ninety‑four (87.0%) were aware of the current national guidelines for management of malaria and 45 (41.7%) had read the guidelines. Correctness of prescription was obtained from 39 (36.0%) respondents in uncomplicated malaria cases and 44 (40.7%) in severe malaria cases.This finding did not significantly associate with the years of practice, level of practice, practicing institutions, awareness, and reading of the national guideline. Conclusions: Most pediatric residents have not read nor use the national guidelines for management of malaria which reflected in poor prescription pattern of antimalarial drugs in routine practice

Impact of home-based management on malaria outcome in under-fives presenting in a tertiary health institution in Nigeria

Abstract Background Home-based management of malaria involves prompt delivery of effective malaria treatment at the community by untrained caregiver. The aim of this study was to document home-based treatment of suspected malaria by non-medical caregivers and to identify its health impact on malaria outcome (severe malaria prevalence, parasite load and mortality) in children (6–59 months). Methods A descriptive cross-sectional study carried out from June 2012–July 2013. Data was obtained by researcher-administered questionnaire and malaria was confirmed in each child by microscopy. Analysis was by Statistical Package for Scientific Solutions version 16. Results Of the 290 caregivers (31.2 ± 6.1 years)/child (21.3 ± 14.4 months) pairs recruited, 222 (76.6%) caregivers managed malaria at home before presenting their children to hospital. Majority (99.0%) practiced inappropriate home-based malaria treatment. While only 35 (15.8%) caregivers used the recommended artemisinin-based combination therapy, most others used paracetamol either solely or in combination with anti-malarial monotherapy [153 (69.0%)]. There was no significant difference in mean [±] parasites count (2055.71 ± 1655.06/µL) of children who received home-based treatment and those who did not (2405.27 ± 1905.77/µL) (t = 1.02, p = 0.31). Prevalence of severe malaria in this study was 111 (38.3%), which was statistically significantly higher in children who received home-based malaria treatment [90.0%] (χ2 = 18.4, OR 4.2, p = 0.00). The mortality rate was 62 per 1000 and all the children that died received home-based treatment (p < 0.001). While low socio-economic class was the significant predictor of prevalence of severe malaria (β = 0.90, OR 2.5, p = 0.00), late presentation significantly predicted mortality (β = 1.87, OR 6.5, p = 0.02). Conclusions The expected benefits of home-based management of malaria in under-fives were undermined by inappropriate treatment practices by the caregivers leading to high incidence of severe malaria and mortality

The diagnostic value of both troponin T and creatinine kinase isoenzyme (CK-MB) in detecting combined renal and myocardial injuries in asphyxiated infants.

Troponin T (cTnT) and Creatinine Kinase Isoenzyme (CK-MB) are both markers of myocardial injuries. However, CK-MB is also elevated in acute kidney injury.The diagnostic value of both cTnT and cardiac CK-MB in combined myocardial and acute kidney injuries (AKI) in asphyxiated neonates was evaluated.40 asphyxiated infants and 40 non-asphyxiated controls were consecutively recruited. Serum levels of cTnT, CK-MB and creatinine were measured. Myocardial injury and AKI were defined as cTnT >95th percentile of the control and serum creatinine >1.0 mg/dl respectively.Of the 40 subjects, 9 (22.50%), 8 (20.00%) and 4 (10.00%) had myocardial injury, AKI and combined AKI and myocardial injuries respectively. The mean cTnT and CK-MB values were highest in infants with combined AKI and myocardial injuries. The Mean cTnT in infants with AKI, myocardial injury and combined AKI and myocardial injuries were 0.010±0.0007 ng/ml, 0.067±0.040 ng/ml and 0.084±0.067 ng/ml respectively, p = 0.006. The mean CK-MB in infants with AKI, myocardial injury and combined AKI and myocardial injuries were 2.78±0.22 ng/ml, 1.28±0.11 ng/ml and 4.58±0.52 ng/ml respectively, p = <0.0001.In severe perinatal asphyxia, renal and myocardial injuries could co-exist. Elevated cTnT signifies the presence of myocardial injury. Elevated CK-MB indicates either myocardial injury, AKI or both. Therefore renal injury should be excluded in asphyxiated infants with elevated CK-MB

The mean cTnT and CKMB levels in infants with renal, myocardial, combined renal and myocardial and no injury.

<p>*Combined = combined renal and myocardial damage.</p><p>The mean and standard deviation of the troponin T value for infants in the ‘none’ column could not be computed by the statistical package because the troponin t values for the infants were too low.</p

Mortality in asphyxiated infants with renal, myocardial, combined renal and myocardial injuries.

<p>P = 0.39.</p