Public Health Division, National Malaria Elimination Programme, Ghana Health Service, Accra, Ghana.
Regional Health Directorate, Northern Region, Ghana Health Service, Accra, Ghana.
Malar J. 2024 Aug 4;23(1):230. doi: 10.1186/s12936-024-05038-2.
Ghana is a malaria-endemic country with the entire population at risk. The Northern region of the country recorded the highest malaria case fatality rate (CFR) for two consecutive years: 1.11% in 2013 and 1.07% in 2014. Even though the National Malaria Elimination Programme (NMEP) has achieved a reduction in malaria mortality, the existence of high case fatality in the Northern region was alarming. This study, therefore, aimed to determine the factors associated with malaria mortality in the northern region of Ghana to institute control measures.
An unmatched case control study was conducted from July 2015 to August 2015. The study population consisted of patients admitted to health facilities for severe malaria in the Northern region of Ghana. A case was defined as a patient diagnosed with severe malaria at an eligible health facility who died as a result of malaria. A control was a patient diagnosed with severe malaria admitted to an eligible health facility who did not die. Health facilities that recorded CFRs of 1.0% and above were randomly sampled for this study, after which, 10 cases and 20 controls were recruited from each health facility. Information on cases and controls was then abstracted from hospital records using an electronically deployed abstraction tool. Continuous variables were expressed as means and medians, and categorical variables as frequencies and proportions. Multivariable logistic regression was used to assess the strength of the association between malaria mortality and factors predictive of malaria mortality. A p-value of < 0.05 was considered statistically significant.
In all, a total of 95 cases and 190 controls participated in this study. The median ages of cases and controls were 4.1 years (IQR = 21.6) and 5.7 years (IQR = 18.2), respectively. Fifty-four (56.8%) cases were females, while 93 (49.0%) of the controls were females. Factors associated with malaria mortality included: duration of hospital stay less than 24 h [aOR: 12.0, 95% CI (5.9-24.6)], severe pallor [aOR: 2.3, 95% CI (1.1-4.6)], children under 5 years [aOR: 2.8, 95% CI (1.4-5.6)], oral Artesunate/Amodiaquine administration [aOR: 0.4, 95% CI (0.2-0.9)] and sepsis as an additional diagnosis [aOR: 4.1, 95% CI (1.8-9.5)].
Predictors of malaria mortality in the Northern region include children under 5 years, severe pallor, sepsis as an additional diagnosis, and use of oral anti-malarial. Patients with severe pallor and sepsis as co-morbidities should receive proactive management. The NMEP and its partners should implement measures to strengthen the referral system, anaemia prevention and management, and retrain health workers on malaria case management. Malaria control interventions targeted at under five children in the region should be reviewed and enhanced.
加纳是一个疟疾流行的国家，全体民众都面临感染风险。该国北部地区连续两年报告了最高的疟疾病死率（CFR）：2013 年为 1.11%，2014 年为 1.07%。尽管国家疟疾消除规划（NMEP）已实现疟疾死亡率降低，但北部地区的高病死率仍令人担忧。因此，本研究旨在确定与加纳北部地区疟疾死亡相关的因素，以便采取控制措施。
本研究采用了 2015 年 7 月至 8 月期间进行的一项未匹配的病例对照研究。研究人群包括在加纳北部地区因严重疟疾而入住医疗机构的患者。病例定义为在符合条件的医疗机构诊断为严重疟疾并因疟疾而死亡的患者。对照为在符合条件的医疗机构诊断为严重疟疾但未死亡的患者。本研究随机抽取了 CFR 为 1.0%及以上的医疗机构，然后从每个医疗机构招募了 10 例病例和 20 例对照。使用电子部署的抽象工具从医院记录中提取病例和对照的信息。连续变量表示为平均值和中位数，分类变量表示为频率和比例。多变量逻辑回归用于评估疟疾死亡率与预测疟疾死亡率的因素之间的关联强度。p 值<0.05 被认为具有统计学意义。
共有 95 例病例和 190 例对照参与了这项研究。病例和对照的中位年龄分别为 4.1 岁（IQR=21.6）和 5.7 岁（IQR=18.2）。54 例（56.8%）病例为女性，93 例（49.0%）对照为女性。与疟疾死亡相关的因素包括：住院时间少于 24 小时[aOR：12.0，95%CI（5.9-24.6）]、严重苍白[aOR：2.3，95%CI（1.1-4.6）]、5 岁以下儿童[aOR：2.8，95%CI（1.4-5.6）]、口服青蒿琥酯/阿莫地喹治疗[aOR：0.4，95%CI（0.2-0.9）]和伴有败血症的附加诊断[aOR：4.1，95%CI（1.8-9.5）]。
北部地区疟疾死亡的预测因素包括 5 岁以下儿童、严重苍白、败血症作为附加诊断以及使用口服抗疟药物。患有严重苍白和败血症等合并症的患者应接受积极的治疗管理。国家疟疾消除规划及其合作伙伴应采取措施，加强转诊系统、贫血的预防和管理，并重新培训卫生工作者进行疟疾病例管理。应审查和加强该地区针对 5 岁以下儿童的疟疾控制干预措施。
