Department of Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda.
Department of Health, Apac District Local Government, Apac, Uganda.
Malar J. 2023 Oct 25;22(1):325. doi: 10.1186/s12936-023-04761-6.
Most data describing severe malaria (SM) in sub-Saharan Africa (SSA) are from research settings outside disease endemic areas. Using routinely collected data from Apac District Hospital, this study aimed at determining the burden and clinical spectrum of severe malaria.
This was a retrospective study that reviewed all paediatric admission records for malaria in the 24 months period from Jan 2019 to Dec 2020 at Apac District Hospital. Data on children aged 60 days to 12 years who at admission tested positive for malaria and fulfilled the World Health Organization clinical criteria for surveillance of severe malaria were abstracted using a customized proforma designed to capture variables on social demographic, clinical presentation, treatment, and outcomes. In addition, the tool included laboratory variables for complete blood counts, haemoglobin, and glucose levels. Data were analysed using STATA V15.0. The study had ethical approval from Mbale Regional Referral Hospital REC, Approval No. MRRH-REC 053/2019.
A total of 5631 admission records were retrieved for this study period. Of these, 3649 (64.8%) were malaria admissions and 3422/3649 were children below 12years, with only 1864 (54.5%) of children having complete data. Of the 1864 children, 745 (40.0%) fulfilled the severe malaria inclusion criteria. Of the 745 children, 51.4% (n = 381) were males. The median age at admission was 31 months (IQR = 17-60). The most common clinical presentations among children with severe malaria were fever 722 (97.3%), cough 478 (64.2%), and difficulty in breathing 122 (17.9%). The median length of hospital stay was 2 (IQR; 2-4) days and 133 (17.9%) had prolonged hospital stay (> 4 days). Factors independently associated with prolonged hospital stay were, presenting with difficulty in breathing, aOR 1.83 (95% CI 1.02-3.27, P = 0.042) and prostration aOR 8.47 (95% CI 1.94-36.99, P = 0.004). A majority of admitted children, 735 (98.7%) survived, while 10 (1.3%) died of SM.
A high proportion (40.0%) of malaria admissions were due to SM. Prolonged Hospital stay was associated with prostration and difficulty in breathing. Overall mortality was low, 1.3% compared to mortality in the previously reported series. This study was able to use routinely collected data to describe the burden and clinical spectrum of SM. Improvement in the quality of data from such settings would improve disease descriptions for policy, monitoring of epidemics, response to interventions and to inform research.
大多数描述撒哈拉以南非洲（SSA）严重疟疾（SM）的数据均来自疾病流行地区以外的研究环境。本研究利用阿帕克区医院的常规收集数据，旨在确定严重疟疾的负担和临床特征。
这是一项回顾性研究，对 2019 年 1 月至 2020 年 12 月期间阿帕克区医院所有因疟疾住院的 60 天至 12 岁儿童的住院记录进行了回顾。采用专门设计的表格，提取入院时检测出疟疾阳性并符合世界卫生组织严重疟疾监测临床标准的儿童的社会人口统计学、临床特征、治疗和结局数据。此外，该工具还包括全血细胞计数、血红蛋白和葡萄糖水平的实验室变量。使用 STATA V15.0 进行数据分析。该研究得到了姆巴莱地区转诊医院 REC 的伦理批准，批准号为 MRRH-REC 053/2019。
本研究期间共检索到 5631 份住院记录。其中，3649 份（64.8%）为疟疾住院，3649 份中 3422 份为 12 岁以下儿童，只有 1864 份（54.5%）的儿童有完整数据。在 1864 名儿童中，745 名（40.0%）符合严重疟疾纳入标准。在 745 名儿童中，51.4%（n=381）为男性。入院时的中位年龄为 31 个月（IQR=17-60）。患有严重疟疾的儿童最常见的临床症状是发热 722 例（97.3%）、咳嗽 478 例（64.2%）和呼吸困难 122 例（17.9%）。中位住院时间为 2（IQR；2-4）天，133 例（17.9%）住院时间延长（>4 天）。与延长住院时间相关的独立因素是呼吸困难，比值比（OR）为 1.83（95%CI 1.02-3.27，P=0.042）和虚脱，OR 为 8.47（95%CI 1.94-36.99，P=0.004）。大多数住院儿童，735 例（98.7%）存活，10 例（1.3%）死于 SM。
相当比例（40.0%）的疟疾住院是由 SM 引起的。延长住院时间与虚脱和呼吸困难有关。总体死亡率较低，为 1.3%，低于之前报道的系列死亡率。本研究能够利用常规收集的数据来描述 SM 的负担和临床特征。改善此类环境中的数据质量将提高政策疾病描述、监测疫情、对干预措施的反应以及为研究提供信息。
