Reducing mortality from severe malaria in Sierra Leonean children by applying the World Health Organization's standard malarial protocol with additional sublingual glucose: A continuous quality improvement report

Asa Oxner, Meghana Vellanki, Andrew Myers, Fonti Bangura, Sheriff Bangura, Augusta Mariama Koroma, Rebecca Massaqoui, Florence Gbao, Dora Kamanda, Joseph Gassimu, Rebecca Kahn

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Objectives: To reduce childhood mortality from severe malaria by implementing the World Health Organization's standardized malarial treatment protocol. Design: Observational study comparing the mortality rate from malaria before and after the intervention. Setting: Inpatient pediatric ward in a district referral hospital of Sierra Leone. Participants: A total of 1298 pediatric patients (ages 0-13 years, male and female) received the intervention, representing 100% of the pediatric patients admitted with severe malaria during the dates of implementation (there were no exclusion criteria). Interventions: We implemented the World Health Organization's standardized malarial protocol on September 30, 2015. Based on monthly run reports of mortality and root cause analysis, we adapted the malaria protocol by adding sublingual glucose as a treatment to target hypoglycemia complications in March 2016. Main Outcome Measures: The primary outcome was a change in monthly percent mortality from severe malaria, and the secondary outcome was the percent of mortality attributed to hypoglycemia. Results: The monthly average percent mortality from severe malaria dropped from 9% to 3.6% after the intervention, which was borderline statistically significant (p 0.06, CI 95% 1.5 to 5.6). The secondary outcome, percent of malarial deaths attributable to hypoglycemia via chart reviews, dropped from 83% to 44% across the study period. There was an increase in the average number of admissions for severe malaria from 71 to 153 children per month in the second half of the year (range from 49-212 per month). Conclusion: Implementing the WHO malaria treatment protocol with bedside tracking of protocol steps reduced malaria mortality and improved our ward's efficiency without adding any human or medical resources.

Original languageEnglish (US)
Pages (from-to)61-67
Number of pages7
JournalInternational Journal of Infectious Diseases
Volume96
DOIs
StatePublished - Jul 2020
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

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