Clinical Features and Mortality Associated with Severe Malaria in Adults in Southern Mauritania.

Boushab Mohamed Boushab,Leonardo Basco,Philippe Parola,Mohamed Salem Ould Ahmedou Salem,Ali Ould Mohamed Salem Boukhary

doi:10.3390/tropicalmed6010001

Abstract

Severe malaria in adults is not well-studied in Sahelian Africa. Clinical features and mortality associated with severe Plasmodium falciparum malaria in adult patients hospitalized in Kiffa, southern Mauritania, were analysed. Patients over 15 years old admitted for severe malaria between August 2016 and December 2019 were included in the present retrospective study. The World Health Organization (WHO) criteria were used to define severe malaria. The presenting clinical characteristics and outcome were compared. Of 4266 patients hospitalized during the study period, 573 (13.4%) had a positive rapid diagnostic test for malaria, and 99 (17.3%; mean age, 37.5 years; range 15–79 years; sex-ratio M/F, 2.1) satisfied the criteria for severe malaria. On admission, the following signs and symptoms were observed in more than one-fourth of the patients: fever (98%), impairment of consciousness (81.8%), multiple convulsions (70.7%), cardiovascular collapse (61.6%), respiratory distress (43.4%), severe anaemia ≤ 80 g/L (36.4%), haemoglobinuria (27.3%), and renal failure (25.3%). Patients were treated with parenteral quinine or artemether. Fourteen (14.1%) patients died. Multiple convulsions, respiratory distress, severe anaemia, haemoglobinuria, acute renal failure, jaundice, and abnormal bleeding occurred more frequently (p < 0.05) in deceased patients. Mortality due to severe falciparum malaria is high among adults in southern Mauritania. An adoption of the WHO-recommended first-line treatment for severe malaria, such as parenteral artesunate, is required to lower the mortality rate associated with severe malaria.

Highlights

Malaria is one of the major public health problems in Mauritania [1]
A total of 4266 patients were hospitalized at Kiffa Regional Hospital, of whom 939 (22.0%) were febrile and screened for malaria during the study period (Figure 2)
In an earlier retrospective study conducted in 2000–2002 in Kaédi (Gorgol region), located along the Senegal River 230 km (508 km by route) southwest of Kiffa, the World Health Organization (WHO) definition of severe malaria was not applied, but it was reported that severe malaria occurred in 480/722 (66.5%) children and adults with presumptive diagnosis of malaria and that coma and convulsions occurred in 53/722 (7.3%) and 77/722 (10.7%), respectively [11]

Summary

Introduction

Malaria is one of the major public health problems in Mauritania [1]. Plasmodium falciparum infections occur mostly in the Sahelian south of the country, where transmission is seasonal (generally from July to October or November) and malaria represents the first cause of outpatient consultation (25%), hospitalization (35.5%), and mortality (39%) [2]. Plasmodium vivax infections predominate in the Saharan northern region of the country, including Nouakchott, the capital city, and Atar, an oasis city [3,4]. Clinical manifestations of malaria disease vary between children and adults [5]. Malaria infection may be asymptomatic in an unknown proportion of human populations in an endemic area.

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Discussion

Conclusion