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Box 2 Mortality of four in-patients who received in-hospital anti-malarial treatment, Uganda

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

Particulars Clinical notes
Quinine One in-patient who received Q during admission died in hospital
Patient 1-Q An 88-year-old female of unknown HIV-status presented with a single admission diagnosis of severe malaria which manifested with fever, chills and unconsciousness. She was referred from a clinic for further management after receiving an initial intramuscular dose of quinine (23 h prior to the current admission). Her vitals on admission were: pulse rate (98 beats per minute); blood pressure (116/63 mmHg); temperature (35.9 °C). Microscopy for malaria parasites was requested on admission (Day 1) but the results were not returned by Day 2. She received 2-doses of Q which were administered 11 h apart, the first dose being 2 h after admission on Day 1. The patient died on Day 2 of hospitalization
Artesunate Two in-patients who received AS during admission died in hospital. None of the two in-patients presented with either an admission or a definitive malaria diagnosis:
Patient 1-AS A 20-year-old female of unknown HIV-status was admitted with suspected severe sepsis of chest focus, bacterial pneumonia, urinary tract infection (UTI), salmonellosis and acute gastroenteritis. Microscopy for malaria parasites was requested on Day 1 but the results were not returned. She missed Day 1 dosing of AS and subsequently received 4 doses of AS. Her definitive diagnoses were UTI, pneumonia and salmonellosis. She died on Day 4 of hospitalization
Patient 2-AS A 24-year-old HIV-positive female presented with severe immunosuppression, sepsis, disseminated tuberculosis and/or tuberculous meningitis, atypical measles syndrome and toxoplasmosis. Microscopy for malaria parasites was not requested on admission. She received 2 doses of AS and never missed Day 1 dosing. Her definitive diagnosis was severe immunosuppression. She died on Day 10 of hospitalization
Artemether + Lumefantrine One in-patient who received AL in hospital died
Patient 1-AL A 23-year-old HIV-positive female presented with working diagnoses of immunosuppression, malaria, septicaemia, urinary tract infection and anaemia. Microscopy for malaria parasites was requested on admission (Day 1) but the results were not returned. Duocotexcin (DP) was prescribed on Day 1 but was neither dispensed nor administered. One dose of AL was administered on Day 3. Her definitive diagnoses were immunosuppression and malaria. She died on Day 6 of hospitalization