<b>Assessment of Pre-Referral Treatment of Severe Malaria Among Children Seen at a Referral Health Facility in South-Western Nigeria</b><b>a.</b>

Background In settings where intravenous artesunate and supportive care cannot be guaranteed, timely and efficient administration of pre-referral antimalarial is crucial. The study aimed to determine the prevalence of pre-referral treatment of severe malaria, the type of pre-referral antimalarial given, and the relationships between pre-referral treatment and outcomes of childhood severe malaria at a referral health facility. Methods This is a retrospective cross-sectional study that involved the review of clinical admission of children aged one month to 15 years referred from a health facility due to suspected severe malaria and who had parasitological evidence of plasmodium falciparum. Diagnosis of severe malaria was made based on clinical features consistent with the World Health Organisation (WHO) criteria. Results 109 medical records were reviewed. The children had a median (IQR) age of 2.0 (4.25) years. The subjects were predominantly male: 59 (54.1%). Forty-six (42.2%) received pre-referral antimalarial; intramuscular artemether was the most common pre-referral antimalarial drug recorded in 33 (30.3%) of the participants. None received rectal artesunate as a pre-referral antimalaria drug. Severe anaemia, prostration, and cerebral malaria were the most frequent components of severe malaria occurring in 26 (23.9%), 24 (22.0%), and 23 (21.1%) participants, respectively. Six (5.5%) of the participants died and all of them did not receive pre-referral antimalarial treatment There was a statistically significant relationship between pre-referral antimalarial treatment and disease outcome (p = 0.024), as none of the children who died from severe malaria received pre-referral treatment. Conclusions: The proportion of children with severe malaria who received pre-referral antimalarial was 42.2%. Intramuscular artemether was the most common pre-referral antimalarial given. Pre-referral antimalaria treatment reduces mortality associated with severe malaria in children.