Malaria treatment-related risks: prevalence and pattern of traumatic injection neuropathy in children attending physiotherapy clinic in northern Nigeria

Introduction
In regions where malaria is endemic, antimalarial drug injections are frequently used to treat children with febrile illnesses. However, these injections carry significant risks, including pain, infection, bleeding, and nerve injuries. Traumatic injection neuropathy, particularly affecting the sciatic nerve, can result from improper injection techniques and the use of neurotoxic drugs. This condition is of particular concern in low-resource settings, where healthcare is often provided by inadequately trained personnel, and medical oversight may be limited. Despite these risks, antimalarial injections remain a common treatment method, contributing to complications like injection-induced nerve injuries, especially in children.

Aim
This study aimed to investigate the prevalence and potential predisposing factors of injection-related trauma among pediatric patients attending the Physiotherapy Clinic at the Federal Medical Centre in Azare, Bauchi State.

Material and methods
The profiles of children who presented with traumatic injection neuropathy over a five-year period (2019-2022) were retrospectively examined.

Results
Among the 168 pediatric patients managed at the physiotherapy clinic during the study period, 43 (23.62%) with sciatic nerve palsy were reviewed. Most patients (51.16%) were aged 5 years or younger. Malaria accounted for 70.20% of the injection administrations, followed by unspecified fever (12.10%) and headache/malaise (4.30%). Notably, 13.40% of the patients lacked a documented medical diagnosis. Injection sites varied, with 60.15% administered at patent medicine vendors/chemist shops, 14.30% at formal healthcare settings, and 10.25% self-administered at home, while 15.30% lacked documented locations. Arthemetre/atesunate constituted the majority (50.00%) of the injections, followed by chloroquine (13.5%) and quinine (5.8%). However, 30.7% of the case reports lacked details about the drugs/injections, and more than 40.50% did not contain information on the overall treatment course or discharge status, although 42.5% indicated full recovery.

Conclusions
This study underscores the need for healthcare policies to deter the establishment of informal or nonmedical settings in Nigeria, particularly for malaria treatment, to mitigate the risk of injection neuropathies and improve patient outcomes