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Selective ambulatory management of Plasmodium falciparum malaria in paediatric refugees
  1. Sarah Cherian (sarah.cherian{at}health.wa.gov.au)
  1. University of Western Australia, Australia
    1. David Burgner (dburgner{at}meddent.uwa.edu.au)
    1. University of Western Australia, Australia

      Abstract

      Background: Plasmodium falciparum (Pf) malaria is a leading cause of childhood mortality and morbidity. In developed countries, it is widely recommended that even uncomplicated cases of Pf malaria are hospitalised for at least 24 hours, whereas ambulatory treatment is usual for uncomplicated infections in developing countries. This observational study assessed the safety of selective admission of paediatric refugees with Pf malaria in Australia.

      Methods: Data were collected on African humanitarian refugee children (<16 years) presenting with malaria between February 2005 and April 2006. Children were treated as outpatients if they fulfilled specific criteria, devised to maximise the safety of outpatient management of this potentially life-threatening condition.

      Results: Ninety paediatric refugees were infected with P. falciparum, of whom 56 children were treated as outpatients. Of the 34 children admitted to hospital, four had parasite loads ≥d 4%. The majority of children were treated with oral atovaquone-proguanil. Eighty eight patients attended follow-up; all were compliant and none reported side-effects. One infant failed treatment and was subsequently readmitted; he did not meet criteria for severe malaria on either occasion and had been initially treated as an inpatient.

      Conclusions: Using this protocol, outpatient management of refugee children with Pf malaria appears safe, with a minimal complication and treatment failure rate. This approach has rationalised management of paediatric malaria in this carefully selected population and substantially reduced utilisation of hospital resources.

      • Plasmodium falciparum
      • ambulatory care
      • child
      • malaria
      • refugees

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