Epidemiology, therapeutic agents and cost of management of paediatric malaria in a Nigerian tertiary hospital

BACKGROUND AND OBJECTIVES: Malaria is the most widespread parasitic disease in sub-Saharan Africa with associated high morbidity and mortality especially among the highly predisposed population of pregnant women and children of age five years and below. Living in malaria endemic regions of the world has become associated with health and economic hazards placing financial and productive burden on affected households. METHODS: A prospective study of children treated for malaria and other associated illnesses at a Nigeria tertiary health institution between May and October 2003 was undertaken. The various malaria-associated diseases treated were determined from their provisional diagnosis, hospital records and causative agents confirmed from their diagnostic laboratory results. Cost of treatment was determined from the patients' guardian and confirmed from relevant hospital departments. Common drugs for malaria treatment, their costs, relative effectiveness and frequency of use were determined through a completed questionnaire by health officers and patients' guidance. RESULTS: Of 5356 paediatric patients suspected of having malaria, 5100 (95.2%) were confirmed positive for malaria parasites microscopically. Of these, 4119 (80.8%) were aged 0 - 6 years, with children aged 1 to 3 years being mostly affected. Eight hundred and twenty (16.1%) of them were in-patients spending an average of six days on hospital bed. Over 22 million naira (dollar 0.22 m) was spent on the treatment of malaria with drugs accounting for the major cost (66.81%). About 33.7% of the patients had malaria complicated with other diseases. INTERPRETATION AND CONCLUSION: The effectiveness of common therapeutic agents used for malaria treatment, their costs and associated side effects is discussed. Recommendations are made for appropriate care and government subsidy for paediatric malaria management in sub-Saharan Africa.