Characterization of Severe Malaria and Treatment-Related Adverse Drug Reactions among Hospitalised Children, at the KNUST Hospital, Kumasi, Ghana.

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BACKGROUND: Malaria remains one of the most important parasitic causes of mortality among humans, accounting for nearly three million annual deaths globally. Morbidity pattern is thought to vary according to such factors as age, geographic location, non-malaria co-morbidity and level of transmission. A comprehensive picture of the local clinical and epidemiological spectrum of severe malaria would aid early recognition, diagnosis and treatment of the disease. The introduction of the Artemisinin-based Combination Therapy (ACT) policy in Ghana has come with reports of associated adverse drug reactions. In spite of monitoring exercises, data regarding adverse antimalarial treatment-related reactions among hospitalized Ghanaian children remains sketchy. OBJECTIVES: To document the demography of paediatric admissions due to severe malaria, presentation and determinants of clinical symptoms, as well as treatment and treatment-related adverse reactions. METHOD: A prospective observational study examining the clinical manifestations and laboratory features of severe malaria was conducted at the Kwame Nkrumah University of Science and Technology Hospital in Kumasi, Ghana over a one-month period. Children aged between 0 and 144 months with confirmed Plasmodium falciparum infection and expressing at least one sign of severe malaria as defined by the World Health Organization were recruited. Evaluation of data was done for patient demographics, reaction characteristics and outcome of reactions. Assessment of causality severity and risk factors was also done. RESULTS: Of 96 paediatric admissions, there were 82 (85%) malaria cases. Severe falciparum malaria as defined by the World Health Organization accounted for 69 (84%) of all malaria cases. The proportion of males was significantly higher (62.3%, p=0.002) than females. Children under 2 years accounted for 30 (43.5%) of severe malaria cases. The main presentations were anaemia of moderate to severe form (56/69, 81%); fever (52/69, 75%); convulsions (23/69, 33%); impaired consciousness (2/69, 2.9%); impaired consciousness and convulsions (1/69, 1.45%). Prostration was observed in all cases. Children under 5 years of age were associated with anaemia [p=0.018] and neurological symptoms (convulsions, impaired consciousness) [p=0.003]. Parasitaemia was associated with fever [p=0.01]. Clinical presentation of severe malaria was found to be independent of sex. No deaths were recorded in all patients. Quinine was used as treatment in 17(24.6%) of cases; monotherapy with artemisinin derivatives in 37.7% cases and artemisinin-amodiaquine combinations in 27.5% of the cases. The prevalence of treatment-related ADRs was 15.9% and was independent of sex. Incidence of ADRs was significantly higher in older children [p=0.024]. No significant difference was seen between overall incidence of ADRs in males and females. Majority of ADRs were type A, mild, had an unlikely drug cause and resolved fully without any intervention. Multiple concurrent drug therapy was a risk factor for ADRs. CONCLUSION: Prostration, anaemia, fever and convulsions make up the clinical spectrum of severe paediatric malaria, in the study area. Incidence of adverse drug reactions increased significantly with age. Multiple concurrent drug therapy predisposed patients to adverse drug reactions.
A Thesis Submitted in Partial Fulfilment of the Requirements for the Degree of Master of Science in the Department of Clinical and Social Pharmacy.