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Box 1 Missed opportunity for hospital-initiated anti-malarial treatment for four in-patients with malaria parasitaemia as confirmed by microscopy, Uganda

From: Quality of care for adult in-patients with malaria in a tertiary hospital in Uganda

Particulars Clinical notes
Patient 1 A 60-year-old female with unknown HIV-status, 6-year history of hypertension and type 2 diabetes mellitus (DM) presented with poorly controlled DM having defaulted on DM treatment for 8-months. Microscopy for malaria parasites was requested on the day of admission (Day 1). Results were returned on Day 1 with confirmed malaria parasitaemia. AL and paracetamol were prescribed on Day 2 but not dispensed. The patient was discharged on Day 3 without anti-malarial treatment
Patient 2 A 24-year-old female with unknown HIV-status was referred from a clinic where she had been treated for suspected malaria and typhoid with no improvement. She presented with poorly treated malaria and microscopy for malaria parasites was requested on Day 1. Results were returned on Day 2 with confirmed malaria parasitaemia. AL and paracetamol were prescribed on Day 2 but not dispensed and the patient was discharged on Day 2 without anti-malarial treatment
Patient 3 A 44-year-old HIV-negative male was transferred from a referral hospital. He presented with an admission diagnosis of chronic lymphocytic leukaemia and confirmed malaria parasitaemia by microscopy. No fresh request for malaria microscopy was made during the current admission. The patient did not receive any anti-malarial treatment prescription and/or administration both prior to admission and throughout the current hospitalization. He was transferred to Uganda Cancer Institute on Day 3
Patient 4 A 43-year-old HIV-positive female with history of DM who was receiving second-line antiretroviral therapy (tenofovir, lamivudine, lopinavir/ritonavir) and co-trimoxazole presented with an admission diagnosis of colon cancer. Microscopy for malaria parasites was requested on Day 2 and results were returned the same day with confirmed malaria parasitaemia. No anti-malarial treatment was prescribed, dispensed or administered during hospitalization. The patient continued to receive her antiretrovirals and co-trimoxazole; and was transferred to Uganda Cancer Institute on Day 17