Evaluation of the Management of Severe Malaria in Pregnant Women, Children and Adults in Mali

Despite the progress made in the fight against malaria over the past decade, including a significant reduction in malaria-related morbidity and mortality in most sub-Saharan Africa countries, ~ 228 million cases and ~ 405 000 deaths were still recorded worldwide in 2018 (World Malaria Report 2019). Children under 5 and pregnant women are the most vulnerable and therefore the most affected by malaria. In 2018, 32% of consultations in Mali were attributable to malaria, with   3 572 794 suspected cases and 3 457 267 cases tested, of which 66% were confirmed (DHIS2), and 1 178 malaria deaths, representing 22% of all deaths in the country (NLHIS). In pregnant women, 217 715 cases were suspected, of which 112 062 were confirmed (51.5%) (DHIS2).

To control malaria, the WHO recommends the use of artemisinin-based combination therapies (ACTs) for the treatment of target groups, including pregnant women as of the second trimester. For severe malaria, adults and children (including infants, pregnant women in all trimesters and lactating women) must be treated with IV or IM artesunate for at least 24h and until they can tolerate oral medication. Once a patient has received at least 24h of parenteral therapy and can tolerate oral medication, the treatment must be completed with a further 3 days of an oral ACT. In Mali, the National Malaria Control Programme (NMCP) makes the same recommendations. Injectable artesunate is the first-line treatment for severe malaria, followed by IM artemether, then quinine by IV infusion as last choice.

However, in the weekly reports provided by malaria management sites, the use of artemisinin derivatives for severe malaria does not always comply with clinical practice guidelines. This survey will help determine the level of correct and incorrect use, and explore the reasons for healthcare providers’ non-compliance with the severe malaria management guidelines.