Schellenberg D, Menendez C, Kahigwa E, Font F, Galindo C, Acosta C, Schellenberg J A, Aponte J J, Kimario J, Urassa H, Mshinda H, Tanner M, Alonso P
Unidad de Epidemiologia y Bioestadistica, Hospital Clinic/Institut d'Investigaciones Biomèdiques August Pi I Sunyer, Villarroel, Barcelona, Spain.
Am J Trop Med Hyg. 1999 Sep;61(3):431-8. doi: 10.4269/ajtmh.1999.61.431.
Malaria remains the most important parasitic cause of mortality in humans. Its presentation is thought to vary according to the intensity of Plasmodium falciparum transmission. However, detailed descriptions of presenting features and risk factors for death are only available from moderate transmission settings. Such descriptions help to improve case management and identify priority research areas. Standardized systematic procedures were used to collect clinical and laboratory data on 6,624 children admitted to hospital over a 1-year period in an intensely malarious part of Tanzania. Frequencies of signs and symptoms were calculated and their association with a fatal outcome was assessed using multivariate logistic regression. There were 72 deaths among 2,432 malaria cases (case fatality rate [CFR] = 3.0%); 44% of the cases and 54% of the deaths were in individuals less than 1 year of age. There was no association between level of parasitemia and CFR. Increased risk of dying was independently found in all children with hypoglycemia (odds ratio [OR] = 6.7, 95% confidence interval [CI] = 3.9-11.7), in children 1-7 months of age with tachypnea (OR = 8.8, 95% CI = 2.6-30.5) and dehydration (OR = 5.0, 95% CI = 1.9-14.2), and in children 8 months to 4 years of age with chest indrawing (OR = 4.7, 95% CI = 2.0-11.2) and inability to localize a painful stimulus (OR = 6.9, 95% CI = 2.9-16.5). Children in the bottom quartile of weight-for-age were more likely to die (OR = 2.1, 95% CI = 1.3-3.5). Eight percent of the malaria cases had severe anemia (packed cell volume < 15%) but 24% received a blood transfusion. The epidemiology of malaria disease may be more complex than previously thought. Improved case management in a wide variety of health facilities may result from adequate identification and treatment of dehydration and hypoglycemia. Transfusion-requiring anemia is a major problem and sustainable, effective preventive measures are urgently needed.
疟疾仍然是人类最重要的寄生虫致死病因。其临床表现被认为会因恶性疟原虫传播强度的不同而有所差异。然而，关于临床表现特征和死亡风险因素的详细描述仅来自中度传播地区。此类描述有助于改善病例管理并确定重点研究领域。在坦桑尼亚疟疾高发地区，采用标准化系统程序收集了1年期间6624名住院儿童的临床和实验室数据。计算了体征和症状的出现频率，并使用多因素逻辑回归评估了它们与致命结局的关联。2432例疟疾病例中有72例死亡（病死率[CFR]=3.0%）；44%的病例和54%的死亡病例为1岁以下儿童。疟原虫血症水平与病死率之间无关联。所有低血糖儿童（比值比[OR]=6.7，95%置信区间[CI]=3.9 - 11.7）、1 - 7个月龄有呼吸急促（OR = 8.8，95% CI = 2.6 - 30.5）和脱水（OR = 5.0，95% CI = 1.9 - 14.2）的儿童，以及8个月至4岁有胸凹陷（OR = 4.7，95% CI = 2.0 - 11.2）和无法定位疼痛刺激（OR = 6.9，95% CI = 2.9 - 16.5）的儿童独立存在死亡风险增加的情况。年龄别体重处于最低四分位数的儿童死亡可能性更大（OR = 2.1，9�% CI = 1.3 - 3.5）。8%的疟疾病例有严重贫血（红细胞压积<15%），但24%接受了输血。疟疾疾病的流行病学可能比以前认为的更为复杂。通过充分识别和治疗脱水及低血糖，可能会改善各类医疗机构中的病例管理。需要输血的贫血是一个主要问题，迫切需要可持续、有效的预防措施。
