Idris Israel Oluwaseyidayo, Ayeni Gabriel Omoniyi, Iyamu Ihoghosa Osamuyi, Sina-Odunsi Ayomide Busayo, Adebisi Yusuff Adebayo, Obwoya Justin Geno
Department of Field Operation and Project Coordination, Health Pooled Fund, Juba, South Sudan.
Department of Social and Preventive Medicine, V.N Karazin Kharkiv National University, Kharkiv, Ukraine.
Confl Health. 2022 Jun 11;16(1):34. doi: 10.1186/s13031-022-00463-z.
The burden of malaria remains the highest in sub-Saharan Africa and South Sudan is not an exception. The country has borne the brunt of years of chronic warfare and remains endemic of malaria, with increasing mortality and morbidity. Limited data still exists on factors influencing the recurrence of severe malaria, especially in emergency contexts such as South Sudan, affected by various conflicts and humanitarian situations. This study therefore aimed to investigate factors influencing severity of occurrence malaria in selected primary healthcare centres in South Sudan. This would assist and guide in malaria prevention, treatment, and eradication efforts.
We conducted an unmatched case-control study using routinely collected clinic data for individuals aged 1 year and above who received a diagnosis of severe malaria at 3 primary healthcare centres (PHCC); Malual Bab PHCC, Matangai PHCC and Malek PHCC between September 15, 2019 to December 15, 2019 in South Sudan. Patient characteristics were analyzed using simple descriptive statistics. Inferential statistics were also conducted to identify the associated factors influencing recurrence of severe malaria. All analyses were conducted using R Version 3.6.2.
A total of 289 recurrent malaria cases were included in this study. More than half of the participants were female. Overall, the prevalence of severe recurrent malaria was 66.1% (191) while 74.4% (215) did not complete malaria treatment. Among those who did not complete malaria treatment, 76.7% (165) had severe recurrent malaria, while among those who completed malaria treatment 35.1% (26) had severe recurrent malaria (p < 0.001). There is a significant association between marital status (OR 0.33, 95% CI 0.19-0.56, p < 0.001), employment status (OR 0.35, 95% CI 0.14-0.87, p = 0.024), the use of preventive measures (OR 3.82, 95% CI 1.81-8.43, p < 0.001) and nutrition status (OR 0.22, 95% CI 0.13-0.37, p < 0.001). When adjusted for employment, marital status, nutritional and prevention measures in turns using Mantel-Haenszel test of association, this effect remained statistically significant.
Our study showed that there is a high prevalence of severe recurrent malaria in South Sudan and that a significant relationship exists between severe recurrent malaria and antimalarial treatment dosage completion influenced by certain personal and social factors such as marital status, employment status, the use of preventive measures and nutrition status. Findings from our study would be useful for effective response to control and prevent malaria in endemic areas of South Sudan.
疟疾负担在撒哈拉以南非洲地区仍然最为沉重，南苏丹也不例外。该国承受了多年长期战乱的冲击，疟疾仍然流行，死亡率和发病率不断上升。关于影响重症疟疾复发的因素，现有数据仍然有限，尤其是在受各种冲突和人道主义局势影响的南苏丹等紧急情况下。因此，本研究旨在调查南苏丹选定的初级医疗保健中心中影响疟疾严重程度的因素。这将有助于并指导疟疾的预防、治疗和根除工作。
我们进行了一项非匹配病例对照研究，使用在2019年9月15日至2019年12月15日期间于南苏丹的3个初级医疗保健中心（PHCC）；马卢阿尔巴布PHCC、马坦盖PHCC和马勒克PHCC为1岁及以上被诊断为重症疟疾的个体常规收集的临床数据。使用简单描述性统计分析患者特征。还进行了推断统计以确定影响重症疟疾复发的相关因素。所有分析均使用R 3.6.2版本进行。
本研究共纳入289例复发性疟疾病例。超过一半的参与者为女性。总体而言，重症复发性疟疾的患病率为66.1%（191例），而74.4%（215例）未完成疟疾治疗。在未完成疟疾治疗的患者中，76.7%（165例）患有重症复发性疟疾，而在完成疟疾治疗的患者中，35.1%（26例）患有重症复发性疟疾（p<0.001）。婚姻状况（OR 0.33，95%CI 0.19 - 0.56，p<0.001）、就业状况（OR 0.35，95%CI 0.14 - 0.87，p = 0.024）、预防措施的使用（OR 3.82，95%CI 1.81 - 8.43，p<0.001）和营养状况（OR 0.22，95%CI 0.13 - 0.37，p<0.001）之间存在显著关联。当依次使用Mantel - Haenszel关联检验对就业、婚姻状况、营养和预防措施进行调整后，这种影响仍然具有统计学意义。
我们的研究表明，南苏丹重症复发性疟疾的患病率很高，并且重症复发性疟疾与抗疟治疗剂量完成情况之间存在显著关系，这受到婚姻状况、就业状况、预防措施的使用和营养状况等某些个人和社会因素的影响。我们研究的结果将有助于有效应对南苏丹疟疾流行地区的疟疾控制和预防。
