Groupe de Recherche Action en Santé (GRAS), 06 BP, 1028, Ouagadougou, Burkina Faso.
Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP, 2208, Ouagadougou, Burkina Faso.
Malar J. 2023 Jan 6;22(1):6. doi: 10.1186/s12936-022-04433-x.
In the current context of tailoring interventions to maximize impact, it is important that current data of clinical epidemiology guide public health programmes and health workers in the management of severe disease. This study aimed at describing the burden of severe malaria at hospital level in two areas with distinct malaria transmission intensity.
A hospital-based surveillance was established in two regional hospitals located in two areas exposed to different malaria transmission. Data on paediatric severe malaria admissions were recorded using standardized methods from August 2017 to August 2018 with an interruption during the dry season from April to June 2018.
In total, 921 children with severe malaria cases were enrolled in the study. The mean age was 33.9 (± 1.3) and 36.8 (± 1.6) months in lower malaria transmission (LMT) and higher malaria transmission (HMT) areas (p = 0.15), respectively. The geometric mean of asexual P. falciparum density was significantly higher in the LMT area compared to the HMT area: 22,861 trophozoites/µL (95% CI 17,009.2-30,726.8) vs 11,291.9 trophozoites/µL (95% CI 8577.9-14,864.5). Among enrolled cases, coma was present in 70 (9.2%) participants. 196 patients (21.8%) presented with two or more convulsions episodes prior to admission. Severe anaemia was present in 448 children (49.2%). Other clinical features recorded included 184 (19.9%) cases of lethargy, 99 (10.7%) children with incoercible vomiting, 80 (8.9%) patients with haemoglobinuria, 43 (4.8%) children with severe hypoglycaemia, 37 (4.0%) cases where child was unable to drink/suck, 11 (1.2%) cases of patients with circulatory collapse/shock, and 8 cases (0.9%) of abnormal bleeding (epistaxis). The adjusted odds of presenting with coma, respiratory distress, haemoglobinuria, circulatory collapse/shock and hypoglycaemia were significantly higher (respectively 6.5 (95%CI 3.4-12.1); 1.8 (95%CI 1.0-3.2); 2.7 (95%CI 1.6-4.3); 5.9 (95%CI 1.3-27.9); 1.9 (95%CI 1.0-3.6)) in children living in the HMT area compared to those residing in the LMT area. Overall, forty-four children died during hospitalization (case fatality rate 5.0%) with the highest fatalities in children admitted with respiratory distress (26.0%) and those with hypoglycaemia (25.0%).
The study showed that children in the HMT area have a higher risk of presenting with coma, shock/dehydration, haemoglobinuria, hypoglycaemia, and respiratory distress. Case-fatality rate is higher among patients with respiratory distress or hypoglycaemia. Hospital surveillance provides a reliable and sustainable means to monitor the clinical presentation of severe malaria and tailor the training needs and resources allocation for case management.
在当前针对最大影响进行干预措施定制的背景下，临床流行病学的现有数据指导公共卫生计划和卫生工作者对严重疾病进行管理是非常重要的。本研究旨在描述两个疟疾传播强度不同地区医院层面严重疟疾的负担。
在两个地区的两个区域医院建立了基于医院的监测，这两个地区分别暴露在不同的疟疾传播环境中。从 2017 年 8 月至 2018 年 8 月，使用标准化方法记录了儿科严重疟疾住院患者的数据，2018 年 4 月至 6 月的旱季期间有中断。
共纳入 921 例严重疟疾患儿。低疟疾传播（LMT）和高疟疾传播（HMT）地区的平均年龄分别为 33.9（±1.3）和 36.8（±1.6）个月（p=0.15）。LMT 区的无性生殖疟原虫密度的几何平均值明显高于 HMT 区：22861 滋养体/µL（95%CI 17009.2-30726.8）与 11291.9 滋养体/µL（95%CI 8577.9-14864.5）。在纳入的病例中，70 例（9.2%）患儿存在昏迷。196 例（21.8%）患者在入院前出现两次或两次以上惊厥发作。448 例患儿（49.2%）存在严重贫血。记录的其他临床特征包括 184 例（19.9%）昏睡患儿、99 例（10.7%）不能强迫呕吐患儿、80 例（8.9%）血红蛋白尿患儿、43 例（4.8%）严重低血糖患儿、37 例（4.0%）不能吃喝患儿、11 例（1.2%）循环衰竭/休克患儿和 8 例（0.9%）异常出血（鼻出血）患儿。与生活在 LMT 区的患儿相比，昏迷、呼吸窘迫、血红蛋白尿、循环衰竭/休克和低血糖患儿的调整后比值比（OR）显著更高（分别为 6.5（95%CI 3.4-12.1）；1.8（95%CI 1.0-3.2）；2.7（95%CI 1.6-4.3）；5.9（95%CI 1.3-27.9）；1.9（95%CI 1.0-3.6））。住院期间共有 44 名儿童死亡（病死率 5.0%），呼吸窘迫和低血糖患儿的病死率最高（分别为 26.0%和 25.0%）。
本研究表明，HMT 地区的儿童出现昏迷、休克/脱水、血红蛋白尿、低血糖和呼吸窘迫的风险更高。呼吸窘迫或低血糖患儿的病死率更高。医院监测为监测严重疟疾的临床表现和调整病例管理的培训需求和资源分配提供了可靠和可持续的手段。
