Opoka Robert O, Namazzi Ruth, Datta Dibyadyuti, Bangirana Paul, Conroy Andrea L, Goings Michael J, Mellencamp Kagan A, John Chandy C
Medical College East Africa, Aga Khan University, Nairobi, Kenya.
Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda.
Malar J. 2024 Dec 4;23(1):367. doi: 10.1186/s12936-024-05196-3.
Few studies have described post-discharge morbidity of children with specific manifestations of severe malaria (SM) beyond severe malarial anaemia or cerebral malaria.
Children 6 months to 4 years of age admitted at Jinja and Mulago hospitals in Uganda, with one or more of the five most common forms of SM, cerebral malaria (n = 53), respiratory distress syndrome (n = 108), malaria with complicated seizures (n = 160), severe malarial anaemia (n = 155) or prostration (n = 75), were followed for 12 months after discharge, alongside asymptomatic community children (CC) (n = 120) of similar ages recruited from the households or neighbourhoods of the children with SM. Incidence and risk of hospitalizations, death or outpatient clinic visits were compared between children with SM and CC.
312/551 (56.6%) of children with SM had one or more post-discharge hospitalization over 12 months, compared to 37/120 (30.8%) of CC. Frequency of hospitalization was similar across all forms of SM. Compared to CC, children with SM had a significantly higher risk of all-cause hospitalization (adjusted hazard ratio (aHR) 1.91, 95% confidence interval (CI) 1.39-2.63, p < 0.001) and hospitalization for severe malaria (aHR 1.94, CI 1.36-2.78, p < 0.001), but a similar risk of outpatient clinic visits for malaria (aHR 1.24, 95% CI 0.89-1.73, p = 0.20). 82% of hospitalizations in children with SM (575/700) and CC (50/61) were due to malaria.
In this malaria endemic region, children with the five most common forms of SM had higher rates of post-discharge hospitalization than asymptomatic community children, and > 80% of hospitalizations were due to severe malaria. Studies of post-discharge malaria chemoprevention are urgently needed for children with SM, to determine if this treatment can reduce post-discharge morbidity.
很少有研究描述过除严重疟疾贫血或脑型疟疾外，患有严重疟疾特定表现（SM）的儿童出院后的发病率。
在乌干达金贾和穆拉戈医院收治的6个月至4岁儿童中，患有五种最常见SM形式中的一种或多种，即脑型疟疾（n = 53）、呼吸窘迫综合征（n = 108）、伴有复杂惊厥的疟疾（n = 160）、严重疟疾贫血（n = 155）或极度衰弱（n = 75），出院后随访12个月，同时纳入从患有SM的儿童家庭或社区招募的年龄相仿的无症状社区儿童（CC）（n = 120）。比较患有SM的儿童和CC的住院、死亡或门诊就诊的发生率及风险。
312/551（56.6%）患有SM的儿童在12个月内有一次或多次出院后住院，而CC为37/120（30.8%）。所有SM形式的住院频率相似。与CC相比，患有SM的儿童全因住院风险显著更高（调整后风险比（aHR）1.91，95%置信区间（CI）1.39 - 2.63，p < 0.001）以及因严重疟疾住院风险更高（aHR 1.94，CI 1.36 - 2.78，p < 0.001），但疟疾门诊就诊风险相似（aHR 1.24，95% CI 0.89 - 1.73，p = 0.20）。患有SM的儿童（575/700）和CC（50/61）中82%的住院是由疟疾导致。
在这个疟疾流行地区，患有五种最常见SM形式的儿童出院后住院率高于无症状社区儿童，且超过80%的住院是由严重疟疾导致。迫切需要对患有SM的儿童进行出院后疟疾化学预防研究，以确定这种治疗是否能降低出院后发病率。
