title: Management of uncomplicated malaria in children under 13 years of age at a district hospital in Senegal: from official guidelines to usual practices.
abstract: BACKGROUND
  To be effective, national malaria guidelines must be properly followed. This study evaluated nurses' practices in the management of uncomplicated malaria cases at a District Hospital. Its objective was to identify the reasons for discrepancies between official guidelines and usual practices.
  
  
  METHODS
  This study took place at Oussouye hospital, south-western Senegal. Blood smears were available for biological diagnosis in patients aged more than five years while the Integrated Management of Childhood Illness recommended treating fevers presumptively in children under five. First line anti-malarial was Amodiaquine plus sulphadoxine-pyrimethamine (AQ+SP) bi-therapy. Hospital records of children under 13 years of age seen between 2004 and 2005 were reviewed.
  
  
  RESULTS
  Among children treated with anti-malarials, 74% (2, 063/2, 789) received AQ+SP. However, only 22% (406/1, 879) of febrile children and 19% (429/2, 198) of children diagnosed with malaria got a blood smear. Moreover, an anti-malarial was prescribed for 80% (377/474) of children with a negative blood smear.
  
  
  CONCLUSIONS
  The transition from chloroquine to AQ+SP was well followed. Nonetheless, blood smear use was very low and many over-prescriptions were reported. Reasons for discrepancies between guidelines and practices can be classified in three main categories: ambiguous guidelines, health system's dysfunctions and nurses' own considerations. Aside from the strengthening of the public health system, in order to guarantee practices complying with guidelines, training content should be more adapted to nurses' own considerations.
authors.affiliation: IRD, UMR 216 Santé de la mère et de l'enfant en milieu tropical, Université Pairs Descartes, Faculté de Pharmacie, Paris, France. sophie.sarrassat@hotmail.fr
authors.forename: Sophie
authors.initials: S
authors.lastname: Sarrassat
authors.forename: Richard
authors.initials: R
authors.lastname: Lalou
authors.forename: Moustapha
authors.initials: M
authors.lastname: Cissé
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Le Hesran
mesh_terms: D000293:Adolescent; D000655:Amodiaquine / Q000008:administration & dosage; D000962:Antimalarials / Q000008:administration & dosage; D001769:Blood / Q000469:parasitology; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006767:Hospitals, District; D006801:Humans; D007223:Infant; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D009726:Nurses; D011739:Pyrimethamine / Q000008:administration & dosage; D012675:Senegal; D013413:Sulfadoxine / Q000008:administration & dosage
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; D000655:Amodiaquine; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine