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Distinguishing Malaria from Severe Pneumonia among Hospitalized Children who Fulfilled Integrated Management of Childhood Illness Criteria for Both Diseases: A Hospital-Based Study in Mozambique

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  • Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique; Pediatric Radiology Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain; Indonesia Country Office World Health Organization, Jakarta, Indonesia

Malaria and severe pneumonia in hospitalized young children may show striking clinical similarities, making differential diagnosis challenging. We investigated ways to increase diagnostic accuracy in patients hospitalized with clinical symptoms compatible with malaria and severe pneumonia, in an area with high a prevalence of infection with human immunodeficiency virus. A total of 646 children admitted at the Manhiça District Hospital in Manhiça, Mozambique who met the World Health Organization clinical criteria for severe pneumonia and malaria were recruited for 12 months and thoroughly investigated to ascertain an accurate diagnosis. Although symptom overlap between malaria and severe pneumonia was frequent among hospitalized children, true disease overlap was uncommon. Clinical presentation and laboratory determinations were ineffective in reliably distinguishing between the two diseases. Infection with human immunodeficiency virus differentially influenced the epidemiology and clinical presentation of these two infectious diseases, further challenging their discrimination on clinical grounds, and having a greater impact on the current burden and prognosis of severe pneumonia.

Author Notes

*Address correspondence to Quique Bassat, Barcelona Center for International Health Research, Rosselló 132, E-08036 Barcelona, Spain. E-mail: quique.bassat@cresib.cat

Financial support: This study was supported by a grant from the World Health Organization (WHO-C6-181-489). The Centro de Investigaçaõ em Saúde da Manhiça received financial support from the Spanish Agency for International Cooperation. Quique Bassat and Anna Roca were supported at the time of the study by the Spanish Ministry of Science and Innovation (FIS: Contrato post Formación Sanitaria Especializada, Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos III, ref. CM05/00134) and Ramon y Cajal (RYC2008-02777), respectively.

Disclosure: None of the authors has any conflicts of interests.

Authors' addresses: Quique Bassat, Cristina O'Callaghan-Gordo, Núria Díez-Padrisa, Edgar Ayala, Sergi Sanz, Anna Roca, and Pedro L. Alonso, Centre de Recerca en Salut Internacional de Barcelona, Hospital Clínic, Universitat de Barcelona, Rosselló 132, 4art, 08036 Barcelona, Spain, E-mails: quique.bassat@cresib.cat, cristina.ocallaghan@cresib.cat, nuria.diez@cresib.cat, edgar_am12@hotmail.com, ssanz@clinic.ub.es, aroca@mrc.gm, and palonso@clinic.ub.es. Sónia Machevo, Betuel Sigaúque, Luís Morais, Inácio Mandomando, and Tacilta Nhampossa, Centro de Investigaçaõ em Saúde da Manhiça, Rúa 12 Vila da Manhiça, CP1929, Maputo, Mozambique, E-mails: sonia.machevo@manhica.net, betuel.sigauque@manhica.net, musukhamorais@yahoo.com.br, inacio.mandomando@gmail.com, and taciltanha@yahoo.com. Josep L. Ribó, Hospital Universitari Sant Joan de Déu, 08950 Esplugues de Llobregat, Barcelona, Spain, E-mail: jlribo@hsjdbcn.org. Martin Weber, World Health Organization, Indonesia Country Office, Bina Mulia 1 Building, Jalan HR Rasuna Said Kav. 10, Jakarta 12950, Indonesia, E-mail: weberm@who.or.id.

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