Kwambele Lokengama, Ndeezi Grace, Ortiz Yamile Arias, Twesigemuka Sabinah, Nduwimana Martin, Egesa Walufu Ivan, Kumbakulu Patrick Kumbowi, Bafwa Yves Tibamwenda
Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda.
Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Makerere University, Uganda.
Int J Pediatr. 2023 Jul 8;2023:2139016. doi: 10.1155/2023/2139016. eCollection 2023.
Malaria remains one of the leading health problems of the developing world, and acute kidney injury (AKI) is a well-recognized complication of severe malaria in adults; but the clinical importance of AKI in paediatric severe malaria is not well documented. Knowledge of the prevalence and factors associated with AKI among children with severe malaria is among the key strategies, which can help to reduce the burden of AKI among this vulnerable group. . A hospital-based prospective cross-sectional descriptive and analytic study of children with severe malaria was carried out at Kiryandongo General Hospital. The study involved 350 children with severe malaria attending the study site from August to October 2021. Questionnaires were administered to caretakers to obtain sociodemographic characteristics. Medical data were obtained through physical examination followed by laboratory tests. Blood samples were tested for creatinine and blood smear for malaria. Data were analyzed using binary logistic regression (bivariate and multivariate) to assess for the factors associated with AKI. A value < 0.05 was considered statistically significant.
The mean age of children with severe malaria was 7.0 ± 3.8 years, and 54.3% of them were male. Of the 350 children enrolled, 167 had AKI, giving an overall AKI prevalence of 47.7% (95% CI: 42.5-53.0). The factors that were significantly associated with AKI among children with severe malaria included caretaker with no formal education (aOR = 21.0, 95% CI: 1.68-261.18, = 0.018), caretaker with primary education level (aOR = 4.5, 95% CI: 1.41-14.12, = 0.011), age of child < 5 years (aOR = 1.8, 95% CI: 1.07-2.88, = 0.025), history of receiving NSAIDs (aOR = 5.6, 95% CI: 2.34-13.22, < 0.001), moderate anemia (aOR = 3.1, 95% CI: 1.39-6.94, = 0.006), and severe anemia (aOR = 3.8, 95% CI: 1.66-8.55, = 0.002).
The prevalence of AKI was high among children with severe malaria in Kiryandongo General Hospital. Acute kidney injury among children with severe malaria was associated with low level of education of caretakers, age of children less than 5 years, history of receiving NSAIDs, and anemia. The management of severe malaria should include screening for AKI especially in children under five years of age, anemic, and those who have received NSAIDs.
疟疾仍然是发展中世界主要的健康问题之一，急性肾损伤（AKI）是成人重症疟疾公认的并发症；但AKI在儿童重症疟疾中的临床重要性尚无充分记录。了解重症疟疾患儿中AKI的患病率及相关因素是关键策略之一，有助于减轻这一弱势群体中AKI的负担。在基延东戈综合医院对重症疟疾患儿进行了一项基于医院的前瞻性横断面描述性和分析性研究。该研究纳入了2021年8月至10月在研究地点就诊的350名重症疟疾患儿。向看护人发放问卷以获取社会人口学特征。通过体格检查及随后的实验室检查获取医疗数据。检测血样中的肌酐，并进行疟疾血涂片检查。使用二元逻辑回归（双变量和多变量）分析数据，以评估与AKI相关的因素。P值<0.05被认为具有统计学意义。
重症疟疾患儿的平均年龄为7.0±3.8岁，其中54.3%为男性。在纳入的350名儿童中，167名患有AKI，总体AKI患病率为47.7%（95%CI：42.5 - 53.0）。重症疟疾患儿中与AKI显著相关的因素包括：看护人未接受过正规教育（调整后比值比[aOR]=21.0，95%CI：1.68 - 261.18，P = 0.018）、看护人具有小学教育水平（aOR = 4.5，95%CI：1.41 - 14.12，P = 0.011）、儿童年龄<5岁（aOR = 1.8，95%CI：1.07 - 2.88，P = 0.025）、有使用非甾体抗炎药（NSAIDs）的病史（aOR = 5.6，95%CI：2.34 - 13.22，P<0.001）、中度贫血（aOR = 3.1，95%CI：1.39 - 6.94，P = 0.006）和重度贫血（aOR = 3.8，95%CI：1.66 - 8.55，P = 0.002）。
基延东戈综合医院重症疟疾患儿中AKI的患病率较高。重症疟疾患儿的急性肾损伤与看护人的低教育水平、年龄小于5岁、使用NSAIDs的病史以及贫血有关。重症疟疾的管理应包括对AKI进行筛查，尤其是对5岁以下、贫血以及使用过NSAIDs的儿童。
