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Abstract

Malaria remains a major public health problem, particularly in sub-Saharan Africa. The disease carries a high burden in Nigerian society, thus making its treatment very important. The disease also presents with several co-morbidities and complications, thus requiring more drugs for treatment. This study examined the patterns of malaria treatment at General Hospital Amassoma (GHA) in Bayelsa State, Nigeria. A retrospective review of 225 patients' case notes diagnosed with malaria from January 2021 to January 2024 was conducted. The most common co-morbidities with malaria were enteric fever (24%), septicemia (8%), anxiety disorder (8%), anemia (5.33%), helminthiasis (5.33%), and arthritis (5.33%). The most frequently prescribed antimalarial drugs were injection artemether (64%), artemisinin-based combination therapy (ACT) (60%), followed by paracetamol (81.33%), amoxicillin (34.67%), and vitamin B complex (18.67%). Treatment patterns varied based on complicated vs uncomplicated malaria as well as specific co-morbidities. For uncomplicated malaria, common regimens included ACT, injection artemether, amoxicillin, and vitamin B complex. Severe malaria was often treated with parenteral artesunate followed by oral ACT, along with adjunctive medications. Antimalarial treatment adhered to WHO guidelines, though regimens were tailored to individual patient presentations and co-morbidities. These findings provide insights into real-world antimalarial prescribing practices in this endemic region of Nigeria.

Pattern of Antimalarial Treatment in General Hospital, Amassoma, Bayelsa state

Treatment Patterns for Complicated Malaria

Most common complications of malaria as were indicated in this study included enteric fever, septicemia, anxiety disorder, anemia, helminthiasis, arthritis, and early cyeris. Table 4.4 below shows the types of drugs used in treating in the case of occurrence of a particular complication with malaria. In the occurrence of malaria and enteric fever, the most common drugs prescribed were ACT (17.33%), injection arthemether (14.67%), vitamin B. Complex (8%), ciprofloxacin (6.67%), followed by amoxicillin (5.33%). Those with complication of septicemia were treated more with paracetamol (8%), ACT(8%), injection artemether (8%), and amoxicillin (5.33%). Those with complications of anxiety disorder were favoured with prescriptions containing paracetamol (8%), artemether (8%) and Cefuroxime (8%). Other complications as reported are also contained in table 4.4 below.

Table 4.4. Percentage treatment patterns for complicated malaria

4.5.3 Malaria with Other Complications

4.5.4 Severe Malaria with Complications

The study reported that patients with severe malaria were treated with a combination of paracetamol, ACT, and Ibuprofen 400mg, injection. Artemether, Artesunate, Ciprofloxacin, Albendazole, Ceftriaxone, Promethazine, and infusion Dextrose saline 5%. Those patients having severe malaria and enteric fever were mostly treated with paracetamol and ACT, whereas those having severe malaria and anemia were treated with paracetamol, ACT, Ibuprofen 400mg, inj. Artemether, ciprofloxacin, and or Ceftriaxone. This is contained in Table 4.6.

Table 4.6 Percentage occurrence of severe malaria and complications

The study involved 225 respondents with a mean age of 21.25+/-19.58 years, ranging from 1 to 80 years old. Among them, 45.33% were males and 54.67% were females, with 12% being in-patients and 88% out-patients. The most common diseases found in prescriptions containing antimalarials were enteric fever (24%), septicemia (8%), anxiety disorder (8%), anemia (5.33%), helminthiasis (5.33%), and arthritis (5.33%). The most frequently prescribed drugs for antimalarial treatment were Paracetamol (81.33%), and injection. Artemether (64%), tab ACT (60%), Amoxicillin (34.67%), and vitamin B. Complex (18.67%). Complications of malaria included enteric fever, septicemia, anxiety disorder, anemia, helminthiasis, arthritis, and early cyeris. Treatment for complications varied, with different drugs prescribed based on the specific complication. For instance, ACT (17.33%) and injection artemether (14.67%) were commonly prescribed for malaria and enteric fever; Paracetamol (8%), ACT (8%), and injection artemether (8%) were used for septicemia; and Paracetamol (8%), artemether (8%), and Cefuroxime (8%) were favored for anxiety disorder.

Combination treatments were also noted for certain complications. For example, malaria + enteric fever + rhinitis was treated with Paracetamol, vitamin B. Complex, injection artemether, albendazole, Cefuroxime, and promethazine. Patients with severe malaria received various combinations of drugs such as paracetamol, ACT, Ibuprofen 400mg, inj. Artemether, Artesunate, Ciprofloxacin, Albendazole, Ceftriaxone, Promethazine, and ivs Dextrose saline 5%.

Discussion

The result above indicates a higher incidence of malaria infection among the female population [54.67%] as compared to 45.33% of males. This seems to agree with the previous report, malaria transmission varies due to gender and age, the high incidence rate observed in females compared to males might be due to hormonal changes in females which usually lead to loss of their resistance/ This implies that hormonal changes may reduce a woman’s immunity or resistance to malaria infection, making women susceptible and leading to the higher incidence among females [12,13,14,20,28,29,31,32,55,57].

The result also shows that the patterns and mean parasite density show that the age group ≤5 years has the highest malaria infection. Similar findings have been reported in previous studies. The World Health Organization has emphasized the fact that children between the ages of 5 years and below are the most vulnerable group of people, particularly in Africa. This can be attributed to the gradual loss of maternal immunity, coupled with a low level of acquired immunity among children compared to adults. Thus, as age and exposure increase, malaria infection decreases except among the elderly and the immunocompromised. Thus, the focus should be on children between the ages of five years and below, even in urban centers. Prevention against mosquito bites should be intensified through the provision of mosquito nets to such households with children. [34,35,36,38,39,41,52,53,54,40]

For uncomplicated malaria treatment, common drugs included Paracetamol (72.89%), injection artemether (59.56%), tab ACT (53.78%), tab Amoxicillin (34.67%), and Vitamin B. Complex (19.11%) which seems to also conform with the WHO’s treatment guideline of uncomplicated malaria which says treat children and adults with uncomplicated P. falciparum malaria [except pregnant women] with any of the recommended artemisinin-based combination therapies for the duration of 3 days [44,45,46,47,37].

Patients with severe malaria received various combinations of drugs such as paracetamol, ACT, Ibuprofen 400mg, inj. Artemether, Artesunate, Ciprofloxacin, Albendazole, Ceftriaxone, Promethazine, and ivs Dextrose saline 5%. This also seems to conform with the WHO’s treatment guideline for severe malaria which says to treat adults and children with severe malaria [including an infected, pregnant woman in all trimesters and lactating woman] with intravenous and intramuscular artesunate for at least 24hrs until they can tolerate oral medication, once a patient has received at least 24 hrs of parental therapy and can tolerate oral treatment, complete treatment with 3 days of ACT [31,55,56,57].

The study also highlighted the treatment patterns for complicated malaria cases, where different drugs were prescribed based on the specific complications or co-morbidities present. For instance, ACT (17.33%) and injection artemether (14.67%) were commonly prescribed for malaria with enteric fever, while Paracetamol (8%), ACT (8%), and injection artemether (8%) were used for septicemia cases. Combination therapies were also noted for certain complications, such as malaria with enteric fever and rhinitis, treated with Paracetamol, vitamin B. Complex, injection artemether, albendazole, Cefuroxime, and promethazine.

Conclusion

In conclusion, the findings of this study underscore the gender disparity in malaria incidence, with a higher prevalence observed among females, potentially attributed to hormonal changes impacting their immunity. Moreover, the treatment patterns revealed adherence to WHO guidelines for both uncomplicated and severe malaria cases, emphasizing the importance of evidence-based approaches in combating this infectious disease. This insight contributes to our understanding of malaria epidemiology and informs healthcare strategies aimed at reducing its burden, particularly among vulnerable populations.

Overall, the findings underscore the importance of tailoring antimalarial treatment to individual patient presentations, considering co-morbidities, and aligning with evidence-based guidelines to ensure optimal management of this life-threatening disease in malaria-endemic regions.

Recommendations

Healthcare providers should prioritize patient education and counseling to enhance malaria treatment guidelines/ knowledge and medication adherence.

Contribution to Literature

This study's findings have contributed to an existing body of knowledge on ways of improving patient outcomes in malaria treatment, as well as improving healthcare system efficiency.

Acknowledgment

The researchers appreciate the statistician, respondents, and co-researchers for the time.

Conflict of Interest

The researchers declare that there was no conflict of interest.