title: Poor adherence to the malaria management protocol among health workers attending under-five year old febrile children at Omdurman Hospital, Sudan.
abstract: BACKGROUND
  In spite of the World Health Organization recommendations for the treatment of malaria, febrile patients are still infrequently tested and erroneously treated for malaria. This study aimed to investigate the adherence to malaria national protocol for the management of malaria among under five years old children.
  
  
  METHODS
  A cross sectional hospital-based study was conducted during the period from September through December 2013 among febrile children below the age of five years attending the outpatient department of Omdurman Children Hospital, Sudan. Demographic, clinical and laboratory data [blood film, rapid diagnostic test (RDTs), haemoglobin, WBCs and chest X ray] and anti-malarials and/or antibiotics prescription were recorded.
  
  
  RESULTS
  A total of 749 febrile children were enrolled. The mean (SD) age was 37.51 (41.6) months. Less than a half, (327, 43.7%) of children were investigated for malaria using microscopy (271, 82.9%), RDT (4, 1.2%) or both (52, 15.9%). Malaria was not investigated for more than a half, (422, 56.3%) however investigations targeting other causes of fever were requested for them. Malaria was positive in 72 (22%) of the 327 investigated children. Five (1.6%) out of 255 with negative malaria tests were treated by an anti-malarials. Quinine was the most frequently prescribed anti-malarials (65, 72.2%) then artemisinin-based combination therapy (ACT) (2, 27.8%). The majority of the 749 children (655, 87.4%) were prescribed an antibiotic.
  
  
  CONCLUSIONS
  There is a poor adherence to malaria management protocol in Sudan among physicians treating children below five years of age. There was a high rate of antibiotic prescription needs.
authors: College of Medicine, Qassim University, Qassim, Saudi Arabia. jalalbilal2000@gmail.com.
authors: Jalal A
authors: JA
authors: Bilal
authors: College of Medicine, Qassim University, Qassim, Saudi Arabia. gasimgsm@yahoo.com.
authors: Gasim I
authors: GI
authors: Gasim
authors: Faculty of Medicine, University of Khartoum, PO Box 102, Khartoum, Sudan. mtagsir@gmail.com.
authors: Mohamed T
authors: MT
authors: Abdien
authors: Federal Ministry of Health, Khartoum, Sudan. khalid.elmardi@gmail.com.
authors: Khalid A
authors: KA
authors: Elmardi
authors: Ministry of Health, Gezira State, PO Box 492, Medani, Sudan. fatihmmalik@gmail.com.
authors: Elfatih M
authors: EM
authors: Malik
authors: Faculty of Medicine, University of Khartoum, PO Box 102, Khartoum, Sudan. ishagadam@hotmail.com.
authors: Ishag
authors: I
authors: Adam
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D010820:Physicians / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013397:Sudan
chemical_list: D000962:Antimalarials
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