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Malaria care in infants aged under six months in Uganda: an area of unmet needs!

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Show simple item record Mbonye, M. K. Burnett, S. M. Naikoba, S. Colebunders, R. Wouters, K. Weaver, M. R. Van geertruyden, J. P. 2015-12-18T09:56:30Z 2015-12-18T09:56:30Z 2015
dc.identifier.issn 1932-6203
dc.identifier.other ITG-C4A
dc.identifier.other DCS
dc.identifier.other U-HIVCLI
dc.identifier.other JIF
dc.identifier.other DOI
dc.identifier.other FTA
dc.identifier.other OAJ
dc.identifier.other Abstract
dc.identifier.other UPD59
dc.description.abstract BACKGROUND: 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. en_US
dc.language English en_US
dc.subject Protozoal diseases en_US
dc.subject Malaria en_US
dc.subject Plasmodium falciparum en_US
dc.subject Vectors en_US
dc.subject Mosquitoes en_US
dc.subject Anopheles en_US
dc.subject Management en_US
dc.subject Diagnosis en_US
dc.subject Treatment en_US
dc.subject Practices en_US
dc.subject Predictors en_US
dc.subject Infants en_US
dc.subject Parasitemia en_US
dc.subject Prescription en_US
dc.subject Antimalarials en_US
dc.subject Uganda en_US
dc.subject Africa, East en_US
dc.title Malaria care in infants aged under six months in Uganda: an area of unmet needs! en_US
dc.type Article-E en_US
dc.citation.issue 4 en_US
dc.citation.jtitle PLoS ONE en_US
dc.citation.volume 10 en_US
dc.citation.pages e0123283 en_US
dc.citation.jabbreviation PLoS ONE en_US

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