乌干达西部 6 至 59 个月重度疟疾儿童中脑型疟疾的流行情况及其相关因素：一项基于医院的横断面研究。

Prevalence and factors associated with cerebral malaria among children aged 6 to 59 months with severe malaria in Western Uganda: a hospital-based cross-sectional study.

机构信息

Department of Pediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Kampala, Uganda.

Department of Pediatrics and Child Health, Université Libre Des Pays Des Grands Lacs, Goma, Democratic Republic of Congo.

出版信息

BMC Pediatr. 2024 Nov 6;24(1):704. doi: 10.1186/s12887-024-05178-z.

DOI:10.1186/s12887-024-05178-z

PMID:39506687

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11539429/

Abstract

INTRODUCTION

Cerebral malaria, caused by Plasmodium falciparum, represents the most severe neurologic complication of malaria. Its association with high morbidity and mortality rates, especially among young children, underscores its clinical significance. In sub-Saharan Africa, including Uganda, cerebral malaria remains a major health challenge, contributing significantly to the high child mortality rate. Despite advances in malaria control, the burden of cerebral malaria among children under five is substantial, reflecting the need for targeted interventions and improved management strategies. This study aimed to determine the prevalence of cerebral malaria and identify associated factors among children admitted with severe malaria at a tertiary hospital in western Uganda.

METHODS

This was a cross-sectional, descriptive, and analytical study involving children aged 6 to 59 months admitted with severe malaria. The study was conducted from January to March 2023 at Fort Portal Regional Referral Hospital. Severe and cerebral malaria were defined as per the WHO criteria. Sociodemographic, clinical, and laboratory data were collected and analyzed using IBM SPSS version 27. Logistic regression analysis was used to evaluate the factors associated with cerebral malaria. A p-value < 0.05 indicated statistical significance.

RESULTS

A total of 250 children were recruited (mean age 33.1 ± 17.3 months). The prevalence of cerebral malaria was 12.8% (95% CI: 8.9-17.6). Cerebral malaria was independently associated with male sex (aOR: 3.05, 95% CI: 1.20-7.77, p = 0.02), abnormal bleeding (aOR: 13.22, 95% CI: 11.54-15.16, p = 0.001), history of convulsions (aOR 12.20, 95% CI: 10.7-21.69, p = 0.010), acute kidney injury (aOR: 4.50, 95% CI: 1.30-15.53, p = 0.02), and hyponatremia (aOR: 3.47, 95% CI: 1.34-8.96, p = 0.010).

CONCLUSIONS AND RECOMMENDATIONS

The prevalence of cerebral malaria was high among children with severe malaria. Factors associated with cerebral malaria included male gender, history of convulsions, abnormal bleeding, acute kidney injury, and hyponatremia. Targeted interventions and early management are essential to improve clinical outcomes.

摘要

介绍

由恶性疟原虫引起的脑疟疾是疟疾最严重的神经并发症。它与高发病率和死亡率相关，尤其是在幼儿中，突显了其临床意义。在撒哈拉以南非洲，包括乌干达，脑疟疾仍然是一个主要的健康挑战，对儿童死亡率的居高不下有着重要影响。尽管疟疾控制取得了进展，但五岁以下儿童的脑疟疾负担仍然很大，这反映出需要采取有针对性的干预措施和改进管理策略。本研究旨在确定在乌干达西部一家三级医院收治的严重疟疾患儿中脑疟疾的流行情况，并确定其相关因素。

方法

这是一项在 2023 年 1 月至 3 月期间在 Fort Portal 地区转诊医院进行的横断面、描述性和分析性研究，纳入了年龄在 6 至 59 个月的因严重疟疾住院的儿童。严重和脑疟疾的定义均符合世卫组织标准。使用 IBM SPSS 版本 27 收集和分析社会人口统计学、临床和实验室数据。采用 logistic 回归分析评估与脑疟疾相关的因素。p 值<0.05 表示具有统计学意义。

结果

共招募了 250 名儿童（平均年龄 33.1±17.3 个月）。脑疟疾的患病率为 12.8%（95%CI：8.9-17.6）。脑疟疾与男性（优势比[OR]：3.05，95%CI：1.20-7.77，p=0.02）、异常出血（OR：13.22，95%CI：11.54-15.16，p=0.001）、抽搐史（OR：12.20，95%CI：10.7-21.69，p=0.010）、急性肾损伤（OR：4.50，95%CI：1.30-15.53，p=0.02）和低钠血症（OR：3.47，95%CI：1.34-8.96，p=0.010）独立相关。