Unusual clinical spectra of childhood severe malaria during malaria epidemic in eastern Uganda: a prospective study

Malaria Journal

Research

Duncan Banks¹  Simon Taylor-Robinson²  Francis Okello³  Chebet Martin⁴  Abongo Grace⁵  Paul Ongodia⁵  Rita Muhindo⁵  William Okiror⁶  George Paasi⁶  Peter Olupot-Olupot⁶  Charles Benard Okalebo⁶  Hellen Kakungulu⁷  Cate Namayanja⁸  Egiru Emma Isaiah Eregu⁸  Ambrose Okibure⁹ 

[1]Busitema University, TORORO, Uganda

[2]The Open University, Milton Keynes, UK

[3]Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda

[4]Imperial College London, London, UK

[5]Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda

[6]Varimetrics Group Limited, Mbale, Uganda

[7]Department of Pediatrics and Child Health, Busitema University Faculty of Health Sciences, Mbale, Uganda

[8]Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda

[9]Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda

[10]Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda

[11]Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda

[12]Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda

[13]Varimetrics Group Limited, Mbale, Uganda

[14]Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda

[15]Department of Pediatrics and Child Health, Busitema University Faculty of Health Sciences, Mbale, Uganda

[16]Varimetrics Group Limited, Mbale, Uganda

关键词: Clinical spectrum;    Severe malaria;    Child;    Prolonged hospitalization and mortality;   

DOI  :  10.1186/s12936-023-04586-3

 received in 2023-03-22, accepted in 2023-05-11,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundIn sub-Saharan Africa (SSA), malaria remains a public health problem despite recent reports of declining incidence. Severe malaria is a multiorgan disease with wide-ranging clinical spectra and outcomes that have been reported to vary by age, geographical location, transmission intensity over time. There are reports of recent malaria epidemics or resurgences, but few data, if any, focus on the clinical spectrum of severe malaria during epidemics. This describes the clinical spectrum and outcomes of childhood severe malaria during the disease epidemic in Eastern Uganda.MethodsThis prospective cohort study from October 1, 2021, to September 7, 2022, was nested within the ‘Malaria Epidemiological, Pathophysiological and Intervention studies in Highly Endemic Eastern Uganda’ (TMA2016SF-1514-MEPIE Study) at Mbale Regional Referral Hospital, Uganda. Children aged 60 days to 12 years who at admission tested positive for malaria and fulfilled the clinical WHO criteria for surveillance of severe malaria were enrolled on the study. Follow-up was performed until day 28. Data were collected using a customized proforma on social demographic characteristics, clinical presentation, treatment, and outcomes. Laboratory analyses included complete blood counts, malaria RDT (SD BIOLINE Malaria Ag P.f/Pan, Ref. 05FK60-40-1) and blood slide, lactate, glucose, blood gases and electrolytes. In addition, urinalysis using dipsticks (Multistix® 10 SG, SIEMENS, Ref.2300) at the bedside was done. Data were analysed using STATA V15.0. The study had prior ethical approval.ResultsA total of 300 participants were recruited. The median age was 4.6 years, mean of 57.2 months and IQR of 44.5 months. Many children, 164/300 (54.7%) were under 5 years, and 171/300 (57.0%) were males. The common clinical features were prostration 236/300 (78.7%), jaundice in 205/300 (68.3%), severe malarial anaemia in 158/300 (52.7%), black water fever 158/300 (52.7%) and multiple convulsions 51/300 (17.0%), impaired consciousness 50/300(16.0%), acidosis 41/300(13.7%), respiratory distress 26/300(6.7%) and coma in 18/300(6.0%). Prolonged hospitalization was found in 56/251 (22.3%) and was associated with acidosis, P = 0.041. The overall mortality was 19/300 (6.3%). Day 28 follow-up was achieved in 247/300 (82.3%).ConclusionDuring the malaria epidemic in Eastern Uganda, severe malaria affected much older children and the spectrum had more of prostration, jaundice severe malarial anaemia, black water fever and multiple convulsions with less of earlier reported respiratory distress and cerebral malaria.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 6

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