Malaria in patients with sickle cell anaemia: burden, risk factors and outcome at the Laquintinie hospital, Cameroon

Abstract

Background It is believed that the current prevalence of malaria in endemic areas reflects selection for the carrier form of sickle cell trait through a survival advantage. Malaria has been incriminated as a great cause of mortality in people with sickle cell disease (SCD). However, people with SCD, a high-risk group, do not benefit from free or subsisized malaria prevention and treatment in Cameroon unlike other vulnerable groups which may be due to insufficient evidence to guide policy makers. This study aimed at describing clinical and socio-demographic characteristics of patients with malaria, determining the prevalence of malaria in hospitalized children and in those with SCD and without, compare frequency of presentation of malaria related complications (using clinical and laboratory elements that define severe malaria) between children admitted for malaria with SCD and those without and finally, determing the risk factors for death in children admitted for malaria. Methods This was a retrospective analysis of admission records of children age 1 to 18 years with a confirmed malaria diagnosis admitted at the Laquintinie Hospital during January 2015 through December 2018. Clinical features, laboratory characteristics and outcome of malarial infections, stratified by SCD status were studied. Patients with HIV infection, malnutrition, renal failure and discharged against medical advice were excluded from the study. Data were analysed using Epi-info 7 software and analysis done. Chi square test, Odds ratios, CI and student’s t test were used to determine association between variables. Statistical significance was set at p-value ≤0.05. Results The prevalence of malaria was lower among children with SCD than it was among children without SCD (23.5% vs 44.9%). Similarly, among those with a positive microscopy, the mean parasite density was significantly lower among children with SCD than it was among children without SCD (22,875.6 vs 57,053.6 parasites/ μl with t-value − 3.2, p-value 0.002). The mean hemoglobin concentration was lower in SCD as compared to non SCD (5.7 g/l vs 7.4 g/l, t-value − 12.5, p-value < 0.001). Overall mortality in SCD was 3.4% and malaria was reponsible for 20.4% of these deaths as compared to the 35.4% in non SCD patients. Convulsion and impaired consciousness were significantly lower in SCD group (OR:0.1, CI: 0.1–0.3, p value < 0.01 and OR:0.1, CI:0.1–0.2, p-value < 0.001 respectively). Death was significantly higher in SCD patients with malaria as compared to SCD patients admitted for other pathologies (3.2% vs 1.5%., OR:2.2, CI:1–5, p-value 0.050). Conclusion The SCD population has a lower mortality related to malaria compared to the non-SCD population. Meanwhile, within the SCD population, those admitted with malaria are twice more likely to die than those admitted for other pathologies. Jaundice, hepatomegaly and splenomegaly were common in SCD with malaria, however no risk factors for malaria severity or malaria related death was identified.

Malaria: Prevalence and related factors in children at Aba, Southeast Nigeria

“…In our study, 62.5% malaria prevalence rate was observed, which although is much higher compared to the rates observed in Sokoto, Northwest Nigeria (27.2%) [8] and Douala in Cameroon region (23.5%) [9], however, is lower than reported rates in Kano, northwest (72.2%) [10] and Ota, Ogun State, Southwest Nigeria (80%) regions [11]. Higher prevalence in our study could be because of its location, the southern part of Nigeria, with much humid weather, wetter climatic conditions, and a temperature more supportive of widespread breeding of the malaria.…”

“…Thus, we believe location affects the prevalence rates. In a study conducted at Cameroon by Eleonore et al [9], the lower prevalence rate of malaria was documented among children with sickle cell disease (SCD). The sickle cell trait (HbAS) has shown high levels of protection against all forms of malaria across Africa [12,13].…”

“…The sickle cell trait (HbAS) has shown high levels of protection against all forms of malaria across Africa [12,13]. Again, among children with SCD (HbSS), the prevalence of malaria is found to be lower compared to children without SCD [9,13,14]. The previous studies have also shown that glucose-6-phosphate dehydrogenase deficiency protects from severe forms of malaria in children [15,16].…”

Association between haematological parameters and sickle cell genotypes in children with Plasmodium falciparum malaria resident in Kisumu County in western Kenya

“…However, few studies in East Africa and none in Kenya has been undertaken to elucidate the association of these haematological parameters and sickle cell genotypes in P. falciparum infection (28). Recently, a retrospective study involving patients with severe malaria in Cameroon did not nd any signi cant association between these parameters and SCD (29), however, leucocytosis and thrombocytosis have been previously reported to drive sickle cell crises (27,30) (31). This facility is the major referral health facility in Western Kenya for a greater population of 968,909 in an area of 2085.9 km² (31).…”

Association Between Haematological Parameters and Sickle Cell Genotypes in Children With Plasmodium Falciparum Malaria Residents in Kisumu County in Western Kenya

“…However, few studies in East Africa and none in Kenya has been undertaken to elucidate the association of these haematological parameters and sickle cell genotypes in P. falciparum infection (28). Recently, a retrospective study involving patients with severe malaria in Cameroon did not nd any signi cant association between these parameters and SCD (29), however, leucocytosis and thrombocytosis have been previously reported to drive sickle cell crises (27,30). To bridge this knowledge gap, our study determined the association between haematological parameters and sickle cell genotypes in children with P. falciparum infection enrolled at Jaramogi Oginga Teaching and Referral Hospital (JOOTRH), in Kisumu County within western Kenya.…”