1921
Volume 98 Number 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Malaria remains a public health crisis in areas where it has resisted control efforts. In Nchelenge District, a high-transmission area in northern Zambia, malaria accounts for more than one-third of pediatric hospitalizations and nearly one-half of hospital deaths in children. To identify risk factors for death due to malaria, we conducted a retrospective, time-matched case-control study of 126 children hospitalized with malaria who died (cases) and 126 children who survived (controls). There were no differences in age, gender, hemoglobin concentration, or prevalence of severe anemia between cases and controls. Children who died were more likely to come from villages located at greater distances from the hospital than children who survived (median 13.5 versus 3.2 km). Each additional kilometer of distance from the hospital increased the odds of death by 4% (odds ratio 1.04, 95% confidence interval 1.01–1.07, < 0.01). Extent of anemia and admission during periods when blood was unavailable for transfusion were associated with early death ( ≤ 0.03). Delays in initiation of treatment of severe malaria contribute to the increased odds of death in children referred from more distant health centers, and might be mitigated by transportation improvements, capacity at rural health posts to administer treatment before transfer, hospital triage systems that minimize time to treatment, and reliable blood product stores at referral hospitals.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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References

  1. Black RE, 2010. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375: 19691987. [Google Scholar]
  2. World Health Organization, 2017. World Malaria Report. Geneva, Switzerland: WHO Global Malaria Programme.
  3. Mukonka VM, 2014. High burden of malaria following scale-up of control interventions in Nchelenge District, Luapula province, Zambia. Malar J 13: 153. [Google Scholar]
  4. Sypniewska P, Duda JF, Locatelli I, Althaus CR, Althaus F, Genton B, , 2017. Clinical and laboratory predictors of death in African children with features of severe malaria: a systematic review and meta-analysis. BMC Med 15: 147. [Google Scholar]
  5. World Health Organization, 2014. Severe malaria. Trop Med Int Health 19 (Suppl 1): 7131. [Google Scholar]
  6. Ioannidis LJ, Nie CQ, Hansen DS, , 2014. The role of chemokines in severe malaria: more than meets the eye. Parasitology 141: 602613. [Google Scholar]
  7. Sundararajan R, Mwanga-Amumpaire J, Adrama H, Tumuhairwe J, Mbabazi S, Mworozi K, Carroll R, Bangsberg D, Boum Y, 2nd Ware NC, , 2015. Sociocultural and structural factors contributing to delays in treatment for children with severe malaria: a qualitative study in southwestern Uganda. Am J Trop Med Hyg 92: 933940. [Google Scholar]
  8. Pinchoff J, Chaponda M, Shields TM, Sichivula J, Muleba M, Mulenga M, Kobayashi T, Curriero FC, Moss WJ, Southern Africa International Centers of Excellence for Malaria Research, , 2016. Individual and household level risk factors associated with malaria in Nchelenge district, a region with perennial transmission: a serial cross-sectional study from 2012 to 2015. PLoS One 11: e0156717. [Google Scholar]
  9. Schoeps A, Gabrysch S, Niamba L, Sie A, Becher H, , 2011. The effect of distance to health-care facilities on childhood mortality in rural Burkina Faso. Am J Epidemiol 173: 492498. [Google Scholar]
  10. Kadobera D, Sartorius B, Masanja H, Mathew A, Waiswa P, , 2012. The effect of distance to formal health facility on childhood mortality in rural Tanzania, 2005–2007. Glob Health Action 5: 19099. [Google Scholar]
  11. Abdul-Aziz AR, Harris E, Munyakazi L, , 2012. Risk factors in malaria mortality among children in northern Ghana: a case study at the Tamale teaching hospital. Int J Business Social Res 2: 3545. [Google Scholar]
  12. Kazembe LN, Kleinschmidt I, Sharp BL, , 2006. Patterns of malaria-related hospital admissions and mortality among Malawian children: an example of spatial modelling of hospital register data. Malar J 5: 93. [Google Scholar]
  13. Müller O, Garenne M, Kouyate B, Becher H, , 2003. The association between protein-energy malnutrition, malaria morbidity and all-cause mortality in West African children. Trop Med Int Health 8: 507511. [Google Scholar]
  14. Modiano D, Sirima BS, Sawadogo A, Sanou I, Pare J, Konate A, Pagnoni F, , 1998. Severe malaria in Burkina Faso: influence of age and transmission level on clinical presentation. Am J Trop Med Hyg 59: 539542. [Google Scholar]
  15. Snow RW, Guerra CA, Noor AM, Myint HY, Hay SI, , 2005. The global distribution of clinical episodes of Plasmodium falciparum malaria. Nature 434: 214217. [Google Scholar]
  16. Varandas L, Julien M, Van Lerberghe W, Goncalves L, Ferrinho P, , 2000. Independent indicators of outcome in severe paediatric malaria: maternal education, acidotic breathing and convulsions on admission. Ann Trop Paediatr 20: 265271. [Google Scholar]
  17. Bronzan RN, 2007. Bacteremia in Malawian children with severe malaria: prevalence, etiology, HIV coinfection, and outcome. J Infect Dis 195: 895904. [Google Scholar]
  18. Mabeza GF, Biemba G, Brennan AG, Moyo VM, Thuma PE, Gordeuk VR, , 1998. The association of pallor with haemoglobin concentration and mortality in severe malaria. Ann Trop Med Parasitol 92: 663669. [Google Scholar]
  19. Dondorp A, Nosten F, Stepniewska K, Day N, White N, South East Asian Quinine Artesunate Malaria Trial group, , 2005. Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial. Lancet 366: 717725. [Google Scholar]
  20. von Seidlein L, 2012. Predicting the clinical outcome of severe falciparum malaria in African children: findings from a large randomized trial. Clin Infect Dis 54: 10801090. [Google Scholar]
  21. Taylor T, 2006. Standardized data collection for multi-center clinical studies of severe malaria in African children: establishing the SMAC network. Trans R Soc Trop Med Hyg 100: 615622. [Google Scholar]
  22. Mudenda SS, Kamocha S, Mswia R, Conkling M, Sikanyiti P, Potter D, Mayaka WC, Marx MA, , 2011. Feasibility of using a World Health Organization-standard methodology for sample vital registration with verbal autopsy (SAVVY) to report leading causes of death in Zambia: results of a pilot in four provinces, 2010. Popul Health Metr 9: 40. [Google Scholar]
  23. Greenwood BM, Bradley AK, Greenwood AM, Byass P, Jammeh K, Marsh K, Tulloch S, Oldfield FS, Hayes R, , 1987. Mortality and morbidity from malaria among children in a rural area of the Gambia, West Africa. Trans R Soc Trop Med Hyg 81: 478486. [Google Scholar]
  24. Maitland K, , 2016. Severe malaria in African children–the need for continuing investment. N Engl J Med 375: 24162417. [Google Scholar]
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  • Received : 28 Dec 2017
  • Accepted : 11 Feb 2018

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