RT Journal Article
SR Electronic
T1 Prereferral rectal artesunate and referral completion among children with suspected severe malaria in the Democratic Republic of the Congo, Nigeria and Uganda
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e008346
DO 10.1136/bmjgh-2021-008346
VO 7
IS 5
A1 Brunner, Nina C
A1 Omoluabi, Elizabeth
A1 Awor, Phyllis
A1 Okitawutshu, Jean
A1 Tshefu Kitoto, Antoinette
A1 Signorell, Aita
A1 Akano, Babatunde
A1 Ayodeji, Kazeem
A1 Okon, Charles
A1 Yusuf, Ocheche
A1 Athieno, Proscovia
A1 Kimera, Joseph
A1 Tumukunde, Gloria
A1 Angiro, Irene
A1 Kalenga, Jean-Claude
A1 Delvento, Giulia
A1 Lee, Tristan T
A1 Lambiris, Mark J
A1 Ross, Amanda
A1 Cereghetti, Nadja
A1 Visser, Theodoor
A1 Napier, Harriet G
A1 Buj, Valentina
A1 Burri, Christian
A1 Lengeler, Christian
A1 Hetzel, Manuel W
YR 2022
UL http://gh.bmj.com/content/7/5/e008346.abstract
AB Introduction Children who receive prereferral rectal artesunate (RAS) require urgent referral to a health facility where appropriate treatment for severe malaria can be provided. However, the rapid improvement of a child’s condition after RAS administration may influence a caregiver’s decision to follow this recommendation. Currently, the evidence on the effect of RAS on referral completion is limited.Methods An observational study accompanied the roll-out of RAS in three malaria endemic settings in the Democratic Republic of the Congo (DRC), Nigeria and Uganda. Community health workers and primary health centres enrolled children under 5 years with suspected severe malaria before and after the roll-out of RAS. All children were followed up 28 days after enrolment to assess their treatment-seeking pathways.Results Referral completion was 67% (1408/2104) in DRC, 48% (287/600) in Nigeria and 58% (2170/3745) in Uganda. In DRC and Uganda, RAS users were less likely to complete referral than RAS non-users in the pre-roll-out phase (adjusted OR (aOR)=0.48, 95% CI 0.30 to 0.77 and aOR=0.72, 95% CI 0.58 to 0.88, respectively). Among children seeking care from a primary health centre in Nigeria, RAS users were less likely to complete referral compared with RAS non-users in the post-roll-out phase (aOR=0.18, 95% CI 0.05 to 0.71). In Uganda, among children who completed referral, RAS users were significantly more likely to complete referral on time than RAS non-users enrolled in the pre-roll-out phase (aOR=1.81, 95% CI 1.17 to 2.79).Conclusions The findings of this study raise legitimate concerns that the roll-out of RAS may lead to lower referral completion in children who were administered prereferral RAS. To ensure that community-based programmes are effectively implemented, barriers to referral completion need to be addressed at all levels. Alternative effective treatment options should be provided to children unable to complete referral.Trial registrstion number NCT03568344; ClinicalTrials.gov.Data are available upon reasonable request. Individual de-identified participant data that underlie the results reported in this article are available at zenodo.org upon reasonable request (DOI: 10.5281/zenodo.5570278).