Awareness of national malaria management guidelines among house officers in Khartoum state teaching hospitals. Sudan 2018

Background : Malaria is a protozoan disease which can lead to serious complications if not treated early and correctly. The aim of this study to assess the knowledge about malaria management guidelines among house officers. Methods : this is the cross sectional observational study conducted at 6 of Khartoum teaching hospitals Results : The study showed that among the 115 participants evaluated there were 70.4% females and 29.6% were males. 94.8% of participants knew there is malaria management guidelines and 5.2% didn't knew about presence of this guidelines, 58.3% have some information and 10.4% just hear about this guidelines. 89.6% knew the management of simple malaria is an outpatient management. 65.2% of the participants were aware about where to manage the cases of complicated malaria (inpatient or in Intensive Care Unit). 27.8% of the participants were aware about the management of simple malaria in the second and third trimester. Conclusion: Different levels of awareness about malaria management guidelines as whole: 4.3% had an overall poor level of awareness, and 74.8% had an overall average level of awareness and 20.9% had an overall good level of awareness.


Introduction
The aims of medical guideline are guiding decisions and criteria in treatment of specific areas of healthcare regarding diagnosis, management. Such guidelines have been use during the entire history of medicine for thousands of years [1]. It recommend specific care for people with specific conditions and determine how healthcare professionals should deal with it [2]. 3 Malaria is a protozoan disease transmitted by the bite of infected Anopheles mosquitoes by plasmodium parasites. The species of plasmodium [3] are P. falciparum, P. vivax, P. ovale, and P. malariae and almost all deaths are caused by falciparum malaria [4]. The clinical features are headache, malaise, hepatosplenomegaly, anemia and vomiting. Jaundice is common due to hemolysis.
The clinical features of malaria are non-specific and the diagnosis must be suspected in anyone returning from an endemic area who has features of infection.
The risk of severe malaria. P. vivax and P. ovale increase with previous splenectomy [5]. All patients with suspected malaria should be treated on the basis of a confirmed diagnosis by microscopy examination or RDT testing of a blood sample.
High specificity will reduce unnecessary treatment with antimalarial drugs and improve the diagnosis of other febrile illnesses in all setting [6]. The management of malaria based on the severity if it is simple malaria treated by Artemether + lumefantrine according to WHO guidelines [6]. If it is complicated malaria the patient must be hospitalized and treated with artesunate IV quinine IV [7]. During pregnancy the treatment is different according to severity and the trimester. In first trimester if it is simple malaria treated by Quinine plus clindamycin or quinine monotherapy. In second trimester treated by Artemether + lumefantrine or any one from ACT drugs group or artesunate plus clindamycin or quinine. If it is complicated malaria in all trimester treated by artesunate or quinine [8] The aim of this study to assess the house officers knowledge about malaria management guidelines and this study will contribute to increase of teaching and make the junior doctors adhere to this guidelines.  (Table 3). 89.6% knew the management of simple malaria is an outpatient management. 71.3% knew the first line of treatment (lumefantrine + artemether) and only 33% of them knew the second line for the management of simple malaria (Table 4). 65.2% of the participants were aware about where to manage the cases of complicated malaria (inpatient or in ICU) and 74.8% knew the treatment of complicated malaria (Table 5). 71.3% knew the first line of management of malaria in the first trimester (oral quinine). Only 27.8% of the participants were aware about the management of simple malaria in the second and third trimester. 83.5% knew the management of complicated malaria during pregnancy. 36.5% knew the treatment of malaria caused by plasmodium vivax and ovale ( Table 6) The level of awareness of the participants; 4.3% had an overall poor level of awareness "answered less than one third of the questions correctly", and 74.8% had an overall average level of awareness "answered more than one third of the questions correctly" and 20.9% had an overall good level of awareness "answered more than two thirds of the questions correctly" ( Table 7 The limitation of this study are small sample size due to refusal of the Sudan medical council to provide us with the statistics about the registered house officers we was select 115 house officers as sample size which we only think it will be representative with a total of which was distributed among the 6 hospitals.

Conclusion
Different levels of awareness about malaria management guidelines as whole: 4.3% had an overall poor level of awareness, and 74.8% had an overall average level of awareness and 20.9% had an overall good level of awareness.

Declarations
Ethical consideration:

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The ethics committee at each hospital was notified and permission taken, each participant was asked for verbal consent before participating and all conflicts was discussed.

Availability of data and materials:
The data generated and analyzed during the current study are not publicly available because this paper not sent to any perreview.

Competing interest:
No one of authors has a conflict of interest

Funding:
This study was not received any financial supports.