Asa Oxner1, Meghana Vellanki2, Andrew Myers3, Fonti Bangura4, Sheriff Bangura4, Augusta Mariama Koroma4, Rebecca Massaqoui5, Florence Gbao5, Dora Kamanda5, Joseph Gassimu4, Rebecca Kahn4. 1. University of South Florida Morsani College of Medicine, Department of Internal Medicine. 13330 USF Laurel Dr, MDC 80, Tampa, FL, 33612; Partners in Health, Sierra Leone, #25 Saquee Dr, Freetown, Sierra Leone. Electronic address: aoxner@health.usf.edu. 2. University of South Florida Morsani College of Medicine, Department of Internal Medicine. 13330 USF Laurel Dr, MDC 80, Tampa, FL, 33612. 3. University of South Florida Morsani College of Medicine, Department of Internal Medicine. 13330 USF Laurel Dr, MDC 80, Tampa, FL, 33612; Partners in Health, Sierra Leone, #25 Saquee Dr, Freetown, Sierra Leone. 4. Partners in Health, Sierra Leone, #25 Saquee Dr, Freetown, Sierra Leone. 5. Ministry of Health and Sanitation of Sierra Leone, Youyi Building, 5th Floor East Wing, Freetown, Sierra Leone.
Abstract
OBJECTIVES: To reduce childhood mortality from severe malaria by implementing the World Health Organization's standardized malarial treatment protocol. DESIGN: Observational study comparing the mortality rate from malaria before and after the intervention. SETTING: Inpatient pediatric ward in a district referral hospital of Sierra Leone. PARTICIPANTS: A total of 1298 pediatric patients (ages 0-13 years, male and female) received the intervention, representing 100% of the pediatric patients admitted with severe malaria during the dates of implementation (there were no exclusion criteria). INTERVENTIONS: We implemented the World Health Organization's standardized malarial protocol on September 30, 2015. Based on monthly run reports of mortality and root cause analysis, we adapted the malaria protocol by adding sublingual glucose as a treatment to target hypoglycemia complications in March 2016. MAIN OUTCOME MEASURES: The primary outcome was a change in monthly percent mortality from severe malaria, and the secondary outcome was the percent of mortality attributed to hypoglycemia. RESULTS: The monthly average percent mortality from severe malaria dropped from 9% to 3.6% after the intervention, which was borderline statistically significant (p 0.06, CI 95% 1.5 to 5.6). The secondary outcome, percent of malarial deaths attributable to hypoglycemia via chart reviews, dropped from 83% to 44% across the study period. There was an increase in the average number of admissions for severe malaria from 71 to 153 children per month in the second half of the year (range from 49-212 per month). CONCLUSION: Implementing the WHO malaria treatment protocol with bedside tracking of protocol steps reduced malaria mortality and improved our ward's efficiency without adding any human or medical resources.
OBJECTIVES: To reduce childhood mortality from severe malaria by implementing the World Health Organization's standardized malarial treatment protocol. DESIGN: Observational study comparing the mortality rate from malaria before and after the intervention. SETTING: Inpatient pediatric ward in a district referral hospital of Sierra Leone. PARTICIPANTS: A total of 1298 pediatric patients (ages 0-13 years, male and female) received the intervention, representing 100% of the pediatric patients admitted with severe malaria during the dates of implementation (there were no exclusion criteria). INTERVENTIONS: We implemented the World Health Organization's standardized malarial protocol on September 30, 2015. Based on monthly run reports of mortality and root cause analysis, we adapted the malaria protocol by adding sublingual glucose as a treatment to target hypoglycemia complications in March 2016. MAIN OUTCOME MEASURES: The primary outcome was a change in monthly percent mortality from severe malaria, and the secondary outcome was the percent of mortality attributed to hypoglycemia. RESULTS: The monthly average percent mortality from severe malaria dropped from 9% to 3.6% after the intervention, which was borderline statistically significant (p 0.06, CI 95% 1.5 to 5.6). The secondary outcome, percent of malarial deaths attributable to hypoglycemia via chart reviews, dropped from 83% to 44% across the study period. There was an increase in the average number of admissions for severe malaria from 71 to 153 children per month in the second half of the year (range from 49-212 per month). CONCLUSION: Implementing the WHO malaria treatment protocol with bedside tracking of protocol steps reduced malariamortality and improved our ward's efficiency without adding any human or medical resources.
Authors: Carina King; Beatiwel Zadutsa; Lumbani Banda; Everlisto Phiri; Eric D McCollum; Josephine Langton; Nicola Desmond; Shamim Ahmad Qazi; Yasir Bin Nisar; Charles Makwenda; Helena Hildenwall Journal: Bull World Health Organ Date: 2022-03-25 Impact factor: 9.408
Authors: Pauline Byakika-Kibwika; Christine Sekaggya-Wiltshire; Jerome Roy Semakula; Jane Nakibuuka; Joseph Musaazi; James Kayima; Cornelius Sendagire; David Meya; Bruce Kirenga; Sarah Nanzigu; Arthur Kwizera; Fred Nakwagala; Ivan Kisuule; Misaki Wayengera; Henry G Mwebesa; Moses R Kamya; William Bazeyo Journal: BMC Infect Dis Date: 2021-12-06 Impact factor: 3.090