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Hospital-based surveillance of severe paediatric malaria in two malaria transmission ecological zones of Burkina Faso

BACKGROUND: In the current context of tailoring interventions to maximize impact, it is important that current data of clinical epidemiology guide public health programmes and health workers in the management of severe disease. This study aimed at describing the burden of severe malaria at hospital...

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Autores principales: Tiono, Alfred B., Konaté, Amadou T., Kargougou, Désiré, Diarra, Amidou, Ouedraogo, Issa Nébié, Ouedraogo, Amidou, Pagnoni, Franco, Modiano, David, Sirima, Sodiomon B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9817371/
https://www.ncbi.nlm.nih.gov/pubmed/36609299
http://dx.doi.org/10.1186/s12936-022-04433-x
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author Tiono, Alfred B.
Konaté, Amadou T.
Kargougou, Désiré
Diarra, Amidou
Ouedraogo, Issa Nébié
Ouedraogo, Amidou
Pagnoni, Franco
Modiano, David
Sirima, Sodiomon B.
author_facet Tiono, Alfred B.
Konaté, Amadou T.
Kargougou, Désiré
Diarra, Amidou
Ouedraogo, Issa Nébié
Ouedraogo, Amidou
Pagnoni, Franco
Modiano, David
Sirima, Sodiomon B.
author_sort Tiono, Alfred B.
collection PubMed
description BACKGROUND: In the current context of tailoring interventions to maximize impact, it is important that current data of clinical epidemiology guide public health programmes and health workers in the management of severe disease. This study aimed at describing the burden of severe malaria at hospital level in two areas with distinct malaria transmission intensity. METHODS: A hospital-based surveillance was established in two regional hospitals located in two areas exposed to different malaria transmission. Data on paediatric severe malaria admissions were recorded using standardized methods from August 2017 to August 2018 with an interruption during the dry season from April to June 2018. RESULTS: In total, 921 children with severe malaria cases were enrolled in the study. The mean age was 33.9 (± 1.3) and 36.8 (± 1.6) months in lower malaria transmission (LMT) and higher malaria transmission (HMT) areas (p = 0.15), respectively. The geometric mean of asexual P. falciparum density was significantly higher in the LMT area compared to the HMT area: 22,861 trophozoites/µL (95% CI 17,009.2–30,726.8) vs 11,291.9 trophozoites/µL (95% CI 8577.9–14,864.5). Among enrolled cases, coma was present in 70 (9.2%) participants. 196 patients (21.8%) presented with two or more convulsions episodes prior to admission. Severe anaemia was present in 448 children (49.2%). Other clinical features recorded included 184 (19.9%) cases of lethargy, 99 (10.7%) children with incoercible vomiting, 80 (8.9%) patients with haemoglobinuria, 43 (4.8%) children with severe hypoglycaemia, 37 (4.0%) cases where child was unable to drink/suck, 11 (1.2%) cases of patients with circulatory collapse/shock, and 8 cases (0.9%) of abnormal bleeding (epistaxis). The adjusted odds of presenting with coma, respiratory distress, haemoglobinuria, circulatory collapse/shock and hypoglycaemia were significantly higher (respectively 6.5 (95%CI 3.4–12.1); 1.8 (95%CI 1.0–3.2); 2.7 (95%CI 1.6–4.3); 5.9 (95%CI 1.3–27.9); 1.9 (95%CI 1.0–3.6)) in children living in the HMT area compared to those residing in the LMT area. Overall, forty-four children died during hospitalization (case fatality rate 5.0%) with the highest fatalities in children admitted with respiratory distress (26.0%) and those with hypoglycaemia (25.0%). CONCLUSION: The study showed that children in the HMT area have a higher risk of presenting with coma, shock/dehydration, haemoglobinuria, hypoglycaemia, and respiratory distress. Case-fatality rate is higher among patients with respiratory distress or hypoglycaemia. Hospital surveillance provides a reliable and sustainable means to monitor the clinical presentation of severe malaria and tailor the training needs and resources allocation for case management.
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spelling pubmed-98173712023-01-07 Hospital-based surveillance of severe paediatric malaria in two malaria transmission ecological zones of Burkina Faso Tiono, Alfred B. Konaté, Amadou T. Kargougou, Désiré Diarra, Amidou Ouedraogo, Issa Nébié Ouedraogo, Amidou Pagnoni, Franco Modiano, David Sirima, Sodiomon B. Malar J Research BACKGROUND: In the current context of tailoring interventions to maximize impact, it is important that current data of clinical epidemiology guide public health programmes and health workers in the management of severe disease. This study aimed at describing the burden of severe malaria at hospital level in two areas with distinct malaria transmission intensity. METHODS: A hospital-based surveillance was established in two regional hospitals located in two areas exposed to different malaria transmission. Data on paediatric severe malaria admissions were recorded using standardized methods from August 2017 to August 2018 with an interruption during the dry season from April to June 2018. RESULTS: In total, 921 children with severe malaria cases were enrolled in the study. The mean age was 33.9 (± 1.3) and 36.8 (± 1.6) months in lower malaria transmission (LMT) and higher malaria transmission (HMT) areas (p = 0.15), respectively. The geometric mean of asexual P. falciparum density was significantly higher in the LMT area compared to the HMT area: 22,861 trophozoites/µL (95% CI 17,009.2–30,726.8) vs 11,291.9 trophozoites/µL (95% CI 8577.9–14,864.5). Among enrolled cases, coma was present in 70 (9.2%) participants. 196 patients (21.8%) presented with two or more convulsions episodes prior to admission. Severe anaemia was present in 448 children (49.2%). Other clinical features recorded included 184 (19.9%) cases of lethargy, 99 (10.7%) children with incoercible vomiting, 80 (8.9%) patients with haemoglobinuria, 43 (4.8%) children with severe hypoglycaemia, 37 (4.0%) cases where child was unable to drink/suck, 11 (1.2%) cases of patients with circulatory collapse/shock, and 8 cases (0.9%) of abnormal bleeding (epistaxis). The adjusted odds of presenting with coma, respiratory distress, haemoglobinuria, circulatory collapse/shock and hypoglycaemia were significantly higher (respectively 6.5 (95%CI 3.4–12.1); 1.8 (95%CI 1.0–3.2); 2.7 (95%CI 1.6–4.3); 5.9 (95%CI 1.3–27.9); 1.9 (95%CI 1.0–3.6)) in children living in the HMT area compared to those residing in the LMT area. Overall, forty-four children died during hospitalization (case fatality rate 5.0%) with the highest fatalities in children admitted with respiratory distress (26.0%) and those with hypoglycaemia (25.0%). CONCLUSION: The study showed that children in the HMT area have a higher risk of presenting with coma, shock/dehydration, haemoglobinuria, hypoglycaemia, and respiratory distress. Case-fatality rate is higher among patients with respiratory distress or hypoglycaemia. Hospital surveillance provides a reliable and sustainable means to monitor the clinical presentation of severe malaria and tailor the training needs and resources allocation for case management. BioMed Central 2023-01-06 /pmc/articles/PMC9817371/ /pubmed/36609299 http://dx.doi.org/10.1186/s12936-022-04433-x Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Tiono, Alfred B.
Konaté, Amadou T.
Kargougou, Désiré
Diarra, Amidou
Ouedraogo, Issa Nébié
Ouedraogo, Amidou
Pagnoni, Franco
Modiano, David
Sirima, Sodiomon B.
Hospital-based surveillance of severe paediatric malaria in two malaria transmission ecological zones of Burkina Faso
title Hospital-based surveillance of severe paediatric malaria in two malaria transmission ecological zones of Burkina Faso
title_full Hospital-based surveillance of severe paediatric malaria in two malaria transmission ecological zones of Burkina Faso
title_fullStr Hospital-based surveillance of severe paediatric malaria in two malaria transmission ecological zones of Burkina Faso
title_full_unstemmed Hospital-based surveillance of severe paediatric malaria in two malaria transmission ecological zones of Burkina Faso
title_short Hospital-based surveillance of severe paediatric malaria in two malaria transmission ecological zones of Burkina Faso
title_sort hospital-based surveillance of severe paediatric malaria in two malaria transmission ecological zones of burkina faso
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9817371/
https://www.ncbi.nlm.nih.gov/pubmed/36609299
http://dx.doi.org/10.1186/s12936-022-04433-x
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