Parenteral artesunate compliance and hospital outcomes in children under five with suspected severe malaria in Sierra Leone

OBJECTIVES To assess compliance with national malaria guidelines for confirmatory diagnosis and parenteral artesunate administration, and to evaluate hospital exit outcomes among children under five admitted with suspected severe malaria. DESIGN A cohort study utilising routinely collected data in Ola During Children’s Hospital, a tertiary paediatric hospital in Freetown, Sierra Leone, from January to December 2024. RESULTS Of 735 admitted children (55% male), 657 (89%) underwent rapid diagnostic tests, but none had microscopic confirmation. A total of 650 (88%) received all three recommended doses of parenteral artesunate at 0, 12, and 24 h. Among the remaining 85 children, 48 (56%) received one or two doses, and 37 received none. Two children died before completion of 24-h dosing schedule. Correct weight-based dosing and scheduling were administered in 420 children (parenteral artesunate compliance = 57% [420/733]). Among admissions, 642 (87%) were discharged and 73 (10%) had unfavourable hospital exit outcomes, including 59 deaths, 13 discharged against medical advice, and 1 absconded. Underweight status, multiple convulsions, and failure to receive correct artesunate dosing were associated with unfavourable hospital exit outcomes. CONCLUSION Compliance with recommended parenteral artesunate dosing was suboptimal, potentially contributing to unfavourable hospital outcomes. Strengthened monitoring, mentorship, and enforcement of malaria management guidelines are urgently needed.