Parenteral artesunate compliance and hospital outcomes in children under five with suspected severe malaria in Sierra Leone.

IF 1.6 Q4 RESPIRATORY SYSTEM

Public Health Action Pub Date : 2026-05-18 eCollection Date: 2026-05-01 DOI:10.5588/pha.25.0047

A R Y Kamara, I F Kamara, P Thekkur, A M Falama, M Sillah-Kanu, W K Lahai, O O Fiona, A George, B D Fofanah, N Sesay, S M Tengbe, L Farma-Grant, A Bah, F Thomas, Y S Tejan, J S Kanu, S Lakoh, M Mustapha, R Zachariah, K Chandrasekharan Prathija, S M Kenneh

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Abstract

Objectives: To assess compliance with national malaria guidelines for confirmatory diagnosis and parenteral artesunate administration, and to evaluate hospital exit outcomes among children under five admitted with suspected severe malaria.

Design: A cohort study utilising routinely collected data in Ola During Children's Hospital, a tertiary paediatric hospital in Freetown, Sierra Leone, from January to December 2024.

Results: Of 735 admitted children (55% male), 657 (89%) underwent rapid diagnostic tests, but none had microscopic confirmation. A total of 650 (88%) received all three recommended doses of parenteral artesunate at 0, 12, and 24 h. Among the remaining 85 children, 48 (56%) received one or two doses, and 37 received none. Two children died before completion of 24-h dosing schedule. Correct weight-based dosing and scheduling were administered in 420 children (parenteral artesunate compliance = 57% [420/733]). Among admissions, 642 (87%) were discharged and 73 (10%) had unfavourable hospital exit outcomes, including 59 deaths, 13 discharged against medical advice, and 1 absconded. Underweight status, multiple convulsions, and failure to receive correct artesunate dosing were associated with unfavourable hospital exit outcomes.

Conclusion: Compliance with recommended parenteral artesunate dosing was suboptimal, potentially contributing to unfavourable hospital outcomes. Strengthened monitoring, mentorship, and enforcement of malaria management guidelines are urgently needed.

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塞拉利昂疑似患有严重疟疾的五岁以下儿童的静脉注射青蒿素依从性和住院结果

目的：评估在确诊诊断和静脉注射青蒿素方面对国家疟疾指南的遵守情况，并评估五岁以下疑似重症疟疾住院儿童的出院结果。设计：一项队列研究，利用2024年1月至12月在塞拉利昂弗里敦的一家三级儿科医院Ola During儿童医院例行收集的数据。结果：735例入院儿童（55%为男性）中，657例（89%）接受了快速诊断试验，但没有一例镜检确诊。共有650人（88%）在0、12和24小时接受了所有三种推荐剂量的静脉注射青蒿琥酯。在其余85名儿童中，48人（56%）接受了一剂或两剂，37人没有接受。2名儿童在完成24小时给药计划前死亡。420名儿童接受了正确的体重给药和计划（静脉注射青蒿琥酯依从性= 57%[420/733]）。入院患者中，642例（87%）出院，73例（10%）出院结果不佳，其中59例死亡，13例不遵医嘱出院，1例潜逃。体重过轻、多次惊厥和未能接受正确的青蒿琥酯剂量与不良的出院结果相关。结论：推荐的静脉注射青蒿琥酯剂量的依从性是次优的，可能导致不良的医院结果。迫切需要加强疟疾管理指南的监测、指导和执行。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Public Health Action RESPIRATORY SYSTEM-

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期刊介绍： Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.