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Gaining time: Early treatment of severe pediatric malaria in Tanzania
Objective: Early effective treatment prevents death or disability from malaria. In malaria-endemic rural areas, pediatric patients who cannot take drugs orally and require injectable treatment have to be transported to the nearest facility that can give injectable malaria drugs. If time to reach the hospital is long, pre-referral treatment and effective referral can play a major positive role.
Methods: We compare the clinical course of illness and time taken to reach hospital in patients from Study 13, a randomized controlled study of pre-referral rectal artesunate in which rapid referral was emphasized, with a comparator group of pediatric patients admitted at the same hospital in Tanzania whose parents' actions prior to admission at the hospital reflected routine behavior.
Results: The key difference was that parents of sick children from the intervention study rapidly transferred their children to the hospital following the advice they were given. Time gained by the referral study was 48 h and this difference was reflected in less severe symptoms at admission.
Conclusions: Efforts to improve referral advice in the community can be a powerful complement to other malaria case management strategies.