Clinical Outcomes of the Pharmacotherapy of Cerebral Malaria among Children in a Nigerian Resource-Limited Facility

Abstract

In resource-limited facilities with a high burden of Cerebral Malaria (CM), it is necessary to identify the pharmacotherapeutic interventions with the best clinical outcomes to reduce morbidity and mortality of the disease. This study aimed at evaluating the clinical outcomes of the pharmacotherapy of CM among children admitted in the Emergency Paediatric Unit (EPU) of Specialists Hospital Sokoto, Nigeria. A Prospective longitudinal study design was used to evaluate eligible children aged ≤5-years and admitted with CM in the facility between July and September 2016. The treatment was based on WHO 2015 guideline for the management of severe malaria. The outcomes of treatments: Blantyre Coma Scale (BCS) score, temperature, and some prognostic information were documented in a structured data collection form from 0 to 96th hours of their admission. The data were analysed using descriptive, T-
test, ANOVA and correlation statistics at p<0.05. The result shows that the average age of the 60 patients evaluated was 3.2±1.5 years. Patients treated with IV-Quinine were observed to have better improvement of BCS score, a better decline in body temperature, higher discharge rate, a lower risk of neurological sequelae and death but with longer duration of hospital stay compared to those on IV-Artesunate. Patients on antibiotics especially ceftriaxone, and diazepam had better improvement in BCS score and decline in their body temperature. In conclusion, patients treated with drug combinations containing IV-Quinine antimalaria, ceftriaxone antibiotic and diazepam had better clinical outcomes. Despite the WHO’s recommendation of IV-Artesunate as the first-line antimalaria for the treatment of CM due to its advantages, clinicians should still consider IV-Quinine as a very good option.