Abstract
BackgroundCharacterization of severe malaria cases on arrival to hospital may lead to early recognition and improved management. Minimum community based-incidence rates (MCBIRs) complement hospital data, describing the malaria burden in the community.MethodsA retrospective analysis of all admitted malaria cases to a Mozambican rural hospital between June 2003 and May 2005 was conducted. Prevalence and case fatality rates (CFR) for each sign and symptom were calculated. Logistic regression was used to identify variables which were independent risk factors for death. MCBIRs for malaria and severe malaria were calculated using data from the Demographic Surveillance System.ResultsAlmost half of the 8,311 patients admitted during the study period had malaria and 13,2% had severe malaria. Children under two years accounted for almost 60% of all malaria cases. CFR for malaria was 1.6% and for severe malaria 4.4%. Almost 19% of all paediatric hospital deaths were due to malaria. Prostration (55.0%), respiratory distress (41.1%) and severe anaemia (17.3%) were the most prevalent signs among severe malaria cases. Severe anaemia and inability to look for mother's breast were independent risk factors for death in infants younger than eight months. For children aged eight months to four years, the risk factors were malnutrition, hypoglycaemia, chest indrawing, inability to sit and a history of vomiting.MCBIRs for severe malaria cases were highest in children aged six months to two years of age. MCBIRs for severe malaria per 1,000 child years at risk for the whole study period were 27 in infants, 23 in children aged 1 to <5 years and two in children aged ≥5 years.ConclusionMalaria remains the number one cause of admission in this area of rural Mozambique, predominantly affecting young children, which are also at higher risk of dying. Measures envisaged to protect children during their first two years of life are likely to have a greater impact than at any other age.
Highlights
Characterization of severe malaria cases on arrival to hospital may lead to early recognition and improved management
Clinical presentation and case fatality rates of children with malaria admitted to the hospital During the two year study period, a total of 8,311 children younger than 15 years were admitted to Manhiça District Hospital
The analysis of the clinical presentation and case fatality rates of children admitted with malaria includes all children who were admitted to the hospital during the study period (n = 8311)
Summary
Characterization of severe malaria cases on arrival to hospital may lead to early recognition and improved management. Out of the 350–550 million malaria cases that are estimated to occur in the world every year [1,2], only around 1–2% are severe or life threatening [3,4,5] This small proportion represents an enormous malaria death toll per year, especially in sub-Saharan Africa, where more than 90% of the malaria deaths are thought to take place every year, affecting mainly children and pregnant women [1,2,6]. Incidence rates of severe malaria among populations in endemic areas are difficult to estimate as the demographic information required is often unavailable, and morbidity data can often only be inferred from hospital records. Data on children with malaria who attend the outpatient clinic of the same hospital are presented in a companion article [13]
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