Author:
ProCite
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Reference Manager
BibTeX
Zotero
EndNote
-
1.
Gething PW et al. 2016. Mapping Plasmodium falciparum mortality in Africa between 1990 and 2015. N Engl J Med 375: 2435–2445.
-
2.
WHO, 2016. World Malaria Report. Geneva, Switzerland: World Health Organization.
-
3.
Maitland K, 2016. Severe malaria in African children—the need for continuing investment. N Engl J Med 375: 2416–2417.
-
4.
Snow RW, Bastos de Azevedo I, Lowe BS, Kabiru EW, Nevill CG, Mwankusye S, Kassiga G, Marsh K, Teuscher T, 1994. Severe childhood malaria in two areas of markedly different falciparum transmission in east Africa. Acta Trop 57: 289–300.
-
5.
Slutsker L, Taylor TE, Wirima JJ, Steketee RW, 1994. In-hospital morbidity and mortality due to malaria-associated severe anaemia in two areas of Malawi with different patterns of malaria infection. Trans R Soc Trop Med Hyg 88: 548–551.
-
6.
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: 539–542.
-
7.
Reyburn H et al. 2005. Association of transmission intensity and age with clinical manifestations and case fatality of severe Plasmodium falciparum malaria. JAMA 293: 1461–1470.
-
8.
Cserti-Gazdewich CM, Dhabangi A, Musoke C, Ssewanyana I, Ddungu H, Nakiboneka-Ssenabulya D, Nabukeera-Barungi N, Mpimbaza A, Dzik WH, 2013. Inter-relationships of cardinal features and outcomes of symptomatic pediatric Plasmodium falciparum malaria in 1,933 children in Kampala, Uganda. Am J Trop Med Hyg 88: 747–756.
-
9.
Uganda Bureau of Statistics (UBOS) and ICF International, 2015. Uganda Malaria Indicator Survey 2014–15. Kampala, Uganda: UBOS and ICF International.
-
10.
Achan J, Tibenderana J, Kyabayinze D, Mawejje H, Mugizi R, Mpeka B, Talisuna A, D’Alessandro U, 2011. Case management of severe malaria–a forgotten practice: experiences from health facilities in Uganda. PLoS One 6: e17053.
-
11.
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: 933–940.
-
12.
Chuma J, Okungu V, Molyneux C, 2010. Barriers to prompt and effective malaria treatment among the poorest population in Kenya. Malar J 9: 144.
-
13.
Uganda Bureau of Statistics (UBOS), 2014. Uganda National Household Survey 2012/2013. Kampala, Uganda: UBOS.
-
14.
Yeka A et al. 2012. Malaria in Uganda: challenges to control on the long road to elimination: I. Epidemiology and current control efforts. Acta Trop 121: 184–195.
-
15.
Uganda Bureau of Statistics (UBOS) and ICF International, 2010. Uganda Malaria Indicator Survey 2009. Calverton, MD: Uganda Bureau of Statistics (UBOS) and ICF International.
-
16.
WHO, Research Malaria Microscopy Standards Working Group, 2015. Microscopy for the Detection, Identification and Quantification of Malaria Parasites on Stained Thick and Thin Films. Geneva, Switzerland: World Health Organization.
-
17.
Murungi M et al. 2017. Improving the specificity of Plasmodium falciparum malaria diagnosis in high-transmission settings with a two-step rapid diagnostic test and microscopy algorithm. J Clin Microbiol 55: 1540–1549.
-
18.
Uganda Ministry of Health, 2012. National Guidelines for the Management of Common Conditions. Kampala, Uganda: Uganda Ministry of Health.
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19.
WHO, 2014. Severe malaria. Trop Med Int Health 19: 7–131.
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20.
WHO, 2015. Guidelines for the Treatment of Malaria. Geneva, Switzerland: World Health Organization.
-
21.
English M, Esamai F, Wasunna A, Were F, Ogutu B, Wamae A, Snow RW, Peshu N, 2004. Assessment of inpatient paediatric care in first referral level hospitals in 13 districts in Kenya. Lancet 363: 1948–1953.
-
22.
Reyburn H, Mwakasungula E, Chonya S, Mtei F, Bygbjerg I, Poulsen A, Olomi R, 2008. Clinical assessment and treatment in paediatric wards in the north-east of the United Republic of Tanzania. Bull World Health Organ 86: 132–139.
-
23.
Dondorp AM et al. AQUAMAT Group, 2010. Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial. Lancet 376: 1647–1657.
-
24.
Hawkes MT et al. 2015. Inhaled nitric oxide as adjunctive therapy for severe malaria: a randomized controlled trial. Malar J 14: 421.
-
25.
Kremsner PG et al. 2016. Intramuscular artesunate for severe malaria in African children: a multicenter randomized controlled trial. PLoS Med 13: e1001938.
-
26.
Day NP, Phu NH, Mai NT, Chau TT, Loc PP, Chuong LV, Sinh DX, Holloway P, Hien TT, White NJ, 2000. The pathophysiologic and prognostic significance of acidosis in severe adult malaria. Crit Care Med 28: 1833–1840.
-
27.
Dondorp AM et al. 2008. The relationship between age and the manifestations of and mortality associated with severe malaria. Clin Infect Dis 47: 151–157.
-
28.
Calis JC et al. 2008. Severe anemia in Malawian children. N Engl J Med 358: 888–899.
-
29.
Kamya MR et al. 2015. Malaria transmission, infection, and disease at three sites with varied transmission intensity in Uganda: implications for malaria control. Am J Trop Med Hyg 92: 903–912.
-
30.
Dorsey G, Staedke S, Clark TD, Njama-Meya D, Nzarubara B, Maiteki-Sebuguzi C, Dokomajilar C, Kamya MR, Rosenthal PJ, 2007. Combination therapy for uncomplicated falciparum malaria in Ugandan children: a randomized trial. JAMA 297: 2210–2219.
-
31.
Wiens MO et al. 2015. A cohort study of morbidity, mortality and health seeking behavior following rural health center visits by children under 12 in southwestern Uganda. PLoS One 10: e0118055.
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32.
Wiens MO et al. 2015. Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction models. BMJ Open 5: e009449.
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33.
Roca-Feltrer A, Carneiro I, Smith L, Schellenberg JR, Greenwood B, Schellenberg D, 2010. The age patterns of severe malaria syndromes in sub-Saharan Africa across a range of transmission intensities and seasonality settings. Malar J 9: 282.
-
34.
Boyce R, Reyes R, Matte M, Ntaro M, Mulogo E, Siedner M, 2017. Use of a dual-antigen rapid diagnostic test to screen children for severe Plasmodium falciparum malaria in a high-transmission, resource-limited setting. Clin Infect Dis 65: 1509–1515.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1014 | 859 | 34 |
| Full Text Views | 645 | 10 | 0 |
| PDF Downloads | 118 | 14 | 0 |
Anemia was an Uncommon Complication of Severe Malaria in a High-Transmission Rural Area of Western Uganda
Ross Boyce
Ross Boyce
Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
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Raquel Reyes
Raquel Reyes
Division of General Medicine & Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
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Corinna Keeler
Corinna Keeler
Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
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Michael Matte
Michael Matte
Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda;
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Moses Ntaro
Moses Ntaro
Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda;
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Edgar Mulogo
Edgar Mulogo
Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda;
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Mark J. Siedner
Mark J. Siedner
Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
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The clinical epidemiology of severe malaria among patients presenting to peripheral health centers has not been well described. We conducted a prospective, observational cohort study to describe the epidemiology and clinical manifestations of severe malaria in a highland area of declining transmission intensity in Western Uganda. Individuals presenting with a history of fever were screened with a malaria rapid diagnostic test (RDT). We prepared blood smears and conducted clinical and laboratory testing for those with a positive RDT. We defined severe malaria in accordance with World Health Organization guidelines for research and epidemiological studies. A total of 6,641 individuals underwent testing for malaria. Ninety-six of 1,462 (6.6%) participants with confirmed parasitemia satisfied the criteria for severe malaria. The incidence of severe malaria peaked between 2 and 3 years of age (incidence rate ratio = 17.1, 95% confidence interval = 8.4–34.9, P < 0.001) and then declined steadily until age 10. However, we also found a second peak among those ≥ 50 years of age. Severe anemia was uncommon, detected in only 5.3% of cases. Instead, shock (22.2%) and lactic acidosis (19.4%) were most frequently encountered. Our results suggest that the clinical characteristics of severe malaria presenting to rural, peripheral health centers may be different than previously observed in referral centers. These findings merit further investigation into the optimal methods for identification and management of severe malaria in rural health centers in the region.
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Author Notes
Financial support: This work was supported by the Harvard Global Health Initiative and Thrasher Research Fund to R.B. Standard Diagnostics provided the rapid diagnostic tests for the study at no cost. Abbott Point of Care provided the iStat analyzers and the associated cartridges to the study. M.J.S. received support from the National Institutes of Health (K23MH099916). R.B. received support from the National Institutes of Health (T32 AI007151). E.M., M.N., and M.M. received grant support for this work from Abbott Point of Care. Neither Standard Diagnostics nor Abbott Point of Care had any role in the design or conduct of the study or preparation of the manuscript.
Authors’ addresses: Ross Boyce, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, E-mail: ross.boyce@unchealth.unc.edu. Raquel Reyes, Division of General Medicine & Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, E-mail: raquel.reyes@med.unc.edu. Corinna Keeler, Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, E-mail: cykeeler@live.unc.edu. Michael Matte, Moses Ntaro, and Edgar Mulogo, Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda, E-mails: mattemichael18@gmail.com, ntaro2001@gmail.com, and emulogo2000@gmail.com. Mark J. Siedner, Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA, E-mail: msiedner@mgh.harvard.edu.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Gething PW et al. 2016. Mapping Plasmodium falciparum mortality in Africa between 1990 and 2015. N Engl J Med 375: 2435–2445.
-
2.
WHO, 2016. World Malaria Report. Geneva, Switzerland: World Health Organization.
-
3.
Maitland K, 2016. Severe malaria in African children—the need for continuing investment. N Engl J Med 375: 2416–2417.
-
4.
Snow RW, Bastos de Azevedo I, Lowe BS, Kabiru EW, Nevill CG, Mwankusye S, Kassiga G, Marsh K, Teuscher T, 1994. Severe childhood malaria in two areas of markedly different falciparum transmission in east Africa. Acta Trop 57: 289–300.
-
5.
Slutsker L, Taylor TE, Wirima JJ, Steketee RW, 1994. In-hospital morbidity and mortality due to malaria-associated severe anaemia in two areas of Malawi with different patterns of malaria infection. Trans R Soc Trop Med Hyg 88: 548–551.
-
6.
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: 539–542.
-
7.
Reyburn H et al. 2005. Association of transmission intensity and age with clinical manifestations and case fatality of severe Plasmodium falciparum malaria. JAMA 293: 1461–1470.
-
8.
Cserti-Gazdewich CM, Dhabangi A, Musoke C, Ssewanyana I, Ddungu H, Nakiboneka-Ssenabulya D, Nabukeera-Barungi N, Mpimbaza A, Dzik WH, 2013. Inter-relationships of cardinal features and outcomes of symptomatic pediatric Plasmodium falciparum malaria in 1,933 children in Kampala, Uganda. Am J Trop Med Hyg 88: 747–756.
-
9.
Uganda Bureau of Statistics (UBOS) and ICF International, 2015. Uganda Malaria Indicator Survey 2014–15. Kampala, Uganda: UBOS and ICF International.
-
10.
Achan J, Tibenderana J, Kyabayinze D, Mawejje H, Mugizi R, Mpeka B, Talisuna A, D’Alessandro U, 2011. Case management of severe malaria–a forgotten practice: experiences from health facilities in Uganda. PLoS One 6: e17053.
-
11.
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: 933–940.
-
12.
Chuma J, Okungu V, Molyneux C, 2010. Barriers to prompt and effective malaria treatment among the poorest population in Kenya. Malar J 9: 144.
-
13.
Uganda Bureau of Statistics (UBOS), 2014. Uganda National Household Survey 2012/2013. Kampala, Uganda: UBOS.
-
14.
Yeka A et al. 2012. Malaria in Uganda: challenges to control on the long road to elimination: I. Epidemiology and current control efforts. Acta Trop 121: 184–195.
-
15.
Uganda Bureau of Statistics (UBOS) and ICF International, 2010. Uganda Malaria Indicator Survey 2009. Calverton, MD: Uganda Bureau of Statistics (UBOS) and ICF International.
-
16.
WHO, Research Malaria Microscopy Standards Working Group, 2015. Microscopy for the Detection, Identification and Quantification of Malaria Parasites on Stained Thick and Thin Films. Geneva, Switzerland: World Health Organization.
-
17.
Murungi M et al. 2017. Improving the specificity of Plasmodium falciparum malaria diagnosis in high-transmission settings with a two-step rapid diagnostic test and microscopy algorithm. J Clin Microbiol 55: 1540–1549.
-
18.
Uganda Ministry of Health, 2012. National Guidelines for the Management of Common Conditions. Kampala, Uganda: Uganda Ministry of Health.
-
19.
WHO, 2014. Severe malaria. Trop Med Int Health 19: 7–131.
-
20.
WHO, 2015. Guidelines for the Treatment of Malaria. Geneva, Switzerland: World Health Organization.
-
21.
English M, Esamai F, Wasunna A, Were F, Ogutu B, Wamae A, Snow RW, Peshu N, 2004. Assessment of inpatient paediatric care in first referral level hospitals in 13 districts in Kenya. Lancet 363: 1948–1953.
-
22.
Reyburn H, Mwakasungula E, Chonya S, Mtei F, Bygbjerg I, Poulsen A, Olomi R, 2008. Clinical assessment and treatment in paediatric wards in the north-east of the United Republic of Tanzania. Bull World Health Organ 86: 132–139.
-
23.
Dondorp AM et al. AQUAMAT Group, 2010. Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial. Lancet 376: 1647–1657.
-
24.
Hawkes MT et al. 2015. Inhaled nitric oxide as adjunctive therapy for severe malaria: a randomized controlled trial. Malar J 14: 421.
-
25.
Kremsner PG et al. 2016. Intramuscular artesunate for severe malaria in African children: a multicenter randomized controlled trial. PLoS Med 13: e1001938.
-
26.
Day NP, Phu NH, Mai NT, Chau TT, Loc PP, Chuong LV, Sinh DX, Holloway P, Hien TT, White NJ, 2000. The pathophysiologic and prognostic significance of acidosis in severe adult malaria. Crit Care Med 28: 1833–1840.
-
27.
Dondorp AM et al. 2008. The relationship between age and the manifestations of and mortality associated with severe malaria. Clin Infect Dis 47: 151–157.
-
28.
Calis JC et al. 2008. Severe anemia in Malawian children. N Engl J Med 358: 888–899.
-
29.
Kamya MR et al. 2015. Malaria transmission, infection, and disease at three sites with varied transmission intensity in Uganda: implications for malaria control. Am J Trop Med Hyg 92: 903–912.
-
30.
Dorsey G, Staedke S, Clark TD, Njama-Meya D, Nzarubara B, Maiteki-Sebuguzi C, Dokomajilar C, Kamya MR, Rosenthal PJ, 2007. Combination therapy for uncomplicated falciparum malaria in Ugandan children: a randomized trial. JAMA 297: 2210–2219.
-
31.
Wiens MO et al. 2015. A cohort study of morbidity, mortality and health seeking behavior following rural health center visits by children under 12 in southwestern Uganda. PLoS One 10: e0118055.
-
32.
Wiens MO et al. 2015. Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction models. BMJ Open 5: e009449.
-
33.
Roca-Feltrer A, Carneiro I, Smith L, Schellenberg JR, Greenwood B, Schellenberg D, 2010. The age patterns of severe malaria syndromes in sub-Saharan Africa across a range of transmission intensities and seasonality settings. Malar J 9: 282.
-
34.
Boyce R, Reyes R, Matte M, Ntaro M, Mulogo E, Siedner M, 2017. Use of a dual-antigen rapid diagnostic test to screen children for severe Plasmodium falciparum malaria in a high-transmission, resource-limited setting. Clin Infect Dis 65: 1509–1515.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1014 | 859 | 34 |
| Full Text Views | 645 | 10 | 0 |
| PDF Downloads | 118 | 14 | 0 |