RECTAL ARTESUNATES AND ITS UTILIZATION IN THE MANAGEMENT OF MALARIA IN CHILDREN IN ABEOKUTA, SOUTH-WESTERN NIGERIA

ABSTRACT Utilization and efficacy of rectal artesunates for the treatment of malaria was assessed in 264 children below the age of 5 years attending two health facilities in Abeokuta, Nigeria. The children systematically selected were 136 from State Hospital Ijaye, (SHA), and 128 from Federal Medical Centre Idi-Aba (FMC). Ethical approvals were obtained in addition to informed consent. To evaluate the efficacy of rectal artesunate, blood samples were collected before and after 24 hours of administration of the drug. Body weight and vital statistics of the children were also measured. The first dose of the rectal artesunate suppository was administered at a dose of 5 to 10mg/kg of the body weight. Giemsa thin and thick film staining techniques were employed to determine parasite species, malaria parasite density (MPC) and percent parasitized red blood cells (PPRBC). Structured questionnaires were administered to parents to determine their knowledge, attitude and practice on utilization and acceptability of rectal artesunate. Data obtained were analyzed using SPSS version 16.0 and EPI INFO version 6.10. Plasmodium falciparum was malaria parasite identified from the blood examination, with a prevalence of 98.8%. Males (55%) were more infected than females (45%), while infection among age and weight groups varied. Chi-square analysis revealed a significant difference between weight and malaria parasite count (p 0.05) among sexes. Chi-square analysis of pre and post-treatment revealed a significant difference between MPC, MPC/µl, PPRBC at p<0.05. This confirmed the efficacy of rectal artesunate in reducing the parasite density (parasitaemia) within 24 hours of treatment. Children with uncomplicated malaria were more (62.88%) when compared with other classes of malaria (moderate malaria (21.97%), severe malaria (15.15%) and cerebral malaria (0%)). Analysis of the questionnaires revealed common symptoms of uncomplicated malaria which include fever (23.10%), and fever and high body temperature (19.24%) and severe malaria, fever, vomiting, high body temperature, loss of appetite and cough (11.46%). Children who visit hospitals were 62.55% as against those that use herbs (20.40%) during malaria infection. Chloroquine derivatives were observed as common drug of choice (41.22%) and in combination with Sulphadoxine-Pyrimethamine (22.55%). The use of rectal artesunate was well accepted by parents (99.6%) and 87.07% of parents agreed that it is easy to administer. The result showed that the use of rectal artesunate was effective and with more enlightenment, the high mortality now experienced in under-five children due to malaria infection would be greatly reduced.