Abstract
BackgroundColombia has officially adopted the parasite density levels of severe malaria established by the WHO (>50,000 parasites/μl). These values have been inferred from areas of high transmission in Africa and are not consistent with the dynamics of low and unstable transmission in Colombia. The objective of this study was therefore to determine the parasite density values observed in patients with severe malaria and their distribution in the different ecoepidemiological regions of Colombia.MethodsA retrospective and descriptive study of confirmed cases of severe malaria was conducted in endemic areas of malaria in Colombia over the period 2014–2017. Data were collected from secondary sources of the Subnational Programs of Malaria Prevention and Control. Person, place, and time variables were selected. The official definition of severe malaria was adopted, and compliance with these criteria was determined. Univariate and bivariate analyses were conducted with absolute and relative frequency measures, and the relevant statistical tests were applied.ResultsThe overall parasite density values in Colombia showed a geometric mean of 5,919 parasites/μl (95% CI: 5,608–6,248). By parasite species, the values were 6,151 (95% CI: 5,631–6,718) for Plasmodium falciparum and 5,815 (95% CI: 5,428–6,230) for Plasmodium vivax. The highest parasite density values were recorded in the Amazon ecoepidemiological region (8,177; 95% CI: 6,015–11,116), and the lowest values were recorded in the Andean region (5,026; 95% CI: 2,409–10,480).ConclusionsIn endemic areas of low and unstable malaria transmission in the Colombian territory, the parasite density levels observed in populations with severe malaria are lower than the officially established values. The parasite density criterion is not really a relevant criterion for the definition of severe cases in Colombia and it certainly not be used to make a clinical decision about the severity of the disease.
Highlights
Despite marked progress in the control and prevention of malaria, the disease remains a major public health problem that contributes to morbidity and mortality, especially in children under 5 years of age [1,2]
In endemic areas of low and unstable malaria transmission in the Colombian territory, the parasite density levels observed in populations with severe malaria are lower than the officially established values
The parasite density criterion is not really a relevant criterion for the definition of severe cases in Colombia and it certainly not be used to make a clinical decision about the severity of the disease
Summary
Despite marked progress in the control and prevention of malaria, the disease remains a major public health problem that contributes to morbidity and mortality, especially in children under 5 years of age [1,2]. Cases of severe malaria can be caused by Plasmodium falciparum or Plasmodium vivax, traditionally, the progression to severe and lethal forms has been attributed mainly to infections by the former species [3]. In Colombia between 2010 and 2018, the surveillance system was notified of a total of 6,684 cases of severe malaria, most of which were caused by P. vivax and more than 95% of the patients were hospitalized and managed in critical care units. Colombia has officially adopted the parasite density levels of severe malaria established by the WHO (>50,000 parasites/μl). These values have been inferred from areas of high transmission in Africa and are not consistent with the dynamics of low and unstable transmission in Colombia.
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