Prospective study on severe malaria among in-patients at Bombo regional hospital, Tanga, north-eastern Tanzania

Msangeni, H.A.; Kamugisha, Mathias; Sembuche, Samuel H; Malecela, E; Akida, Juma A; Temba, Filbert F; Mmbando, Bruno P.; Lemnge, Martha

doi:10.1186/1471-2334-11-256

Cited by 20 publications

(16 citation statements)

References 43 publications

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“…In Tanzania, the clinical manifestations of severe malaria in children younger than five years were cerebral malaria (47.3%) and severe anaemia (14.6%) [4]. Severe anaemia (8.57%) and circulatory collapse (11.90%) were the most common manifestations of severe malaria in neighbouring Ethiopia [13].…”

Section: Discussionmentioning

confidence: 99%

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Severe Plasmodium falciparum and Plasmodium vivax malaria among adults at Kassala Hospital, eastern Sudan

Abdallah

Abdeen

Ahmed

et al. 2013

Malar J

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BackgroundThere have been few published reports on severe Plasmodium falciparum and Plasmodium vivax malaria among adults in Africa.MethodsClinical pattern/manifestations of severe P. falciparum and P. vivax (according to World Health Organization 2000 criteria) were described in adult patients admitted to Kassala Hospital, eastern Sudan.ResultsA total of 139 adult patients (80 males, 57.6%) with a mean (SD) age of 37.2 (1.5) years presented with severe P. falciparum (113, 81.3%) or P. vivax (26, 18.7%) malaria. Manifestations among the 139 patients included hypotension (38, 27.3%), cerebral malaria (23, 16.5%), repeated convulsions (18, 13.0%), hypoglycaemia (15, 10.8%), hyperparasitaemia (14, 10.1%), jaundice (14, 10.1%), severe anaemia (10, 7.2%), bleeding (six, 4.3%), renal impairment (one, 0.7%) and more than one criteria (27, 19.4%). While the geometric mean of the parasite count was significantly higher in patients with severe P. vivax than with severe P. falciparum malaria (5,934.2 vs 13,906.6 asexual stage parasitaemia per μL, p = 0.013), the different disease manifestations were not significantly different between patients with P. falciparum or P. vivax malaria. Three patients (2.2%) died due to severe P. falciparum malaria. One had cerebral malaria, the second had renal impairment, jaundice and hypoglycaemia, and the third had repeated convulsions and hypotension.ConclusionsSevere malaria due to P. falciparum and P. vivax malaria is an existing entity among adults in eastern Sudan. Patients with severe P. falciparum and P. vivax develop similar disease manifestations.

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Section: Discussionmentioning

confidence: 99%

“…In Tanzania, the fatality rate of severe malaria was 3.2% and the majority of deaths occurred in children younger than five years [4]. High mortality rates (33.3%), mainly in young adults, were observed among patients with severe malaria at Dakar, Senegal [23].…”

Section: Discussionmentioning

confidence: 99%

Severe Plasmodium falciparum and Plasmodium vivax malaria among adults at Kassala Hospital, eastern Sudan

Abdallah

Abdeen

Ahmed

et al. 2013

Malar J

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“…Presumptive treatment of fever with antimalarial drugs is still frequent in public health settings of sub-Saharan Africa, even in countries where ACTs, bed nets, malaria diagnosis and IPT are freely provided to vulnerable population [8]. During the last years, the prevalence of fever due to malaria has been drastically reduced in several countries including Gabon [3,6].…”

Section: Discussionmentioning

confidence: 99%

“…The frequency of complicated malaria should also be influenced by interventions. Therefore, the decline of malaria prevalence can also result in a parallel decrease of, or influence the frequency of cerebral malaria (CM) and severe malarial anaemia (SMA) as reported in north-eastern Tanzania and in rural Kenya [8,9]. …”

Section: Introductionmentioning

confidence: 99%

Complicated malaria and other severe febrile illness in a pediatric ward in Libreville, Gabon

et al. 2012

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BackgroundAlthough a substantial decline of Plasmodium falciparum infection is observed in Africa following implementation of new control strategies, malaria is still considered as the major cause of febrile illness in hospitalized African children. The present study was designed to assess the management of febrile illness and to determine the proportion of children with febrile illness hospitalized for primary diagnosis of malaria who had confirmed complicated malaria after implementation of new malaria control strategies in Libreville, Gabon.MethodsDemographic, clinical and biological data from hospitalized children with fever or a history of fever, with a primary diagnosis of clinical malaria, aged less than 18 years old, who benefited from hematological measurements and microscopic malaria diagnosis, were recorded and analyzed during a prospective and observational study conducted in 2008 in the Centre Hospitalier de Libreville.ResultsA total of 418 febrile children were admitted at hospital as malaria cases. Majority of them (79.4%) were aged below five years. After medical examination, 168 were diagnosed and treated as clinical malaria and, among them, only 56.7% (n = 95) had Plasmodium falciparum positive blood smears. Age above five years, pallor, Blantyre Coma Score ≤2 and thrombocytopenia were predictive of malaria infection. Respiratory tract infections were the first leading cause of hospitalization (41.1%), followed by malaria (22.7%); co-morbidities were frequent (22%). Less than 5% of suspected bacterial infections were confirmed by culture. Global case fatality rate was 2.1% and 1% for malaria. Almost half (46%) of the children who received antimalarial therapy had negative blood smears. Likewise, antibiotics were frequently prescribed without bacteriological confirmation.ConclusionsThe use of clinical symptoms for the management of children febrile illness is frequent in Gabon. Information, training of health workers and strengthening of diagnosis tools are necessary to improve febrile children care.

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“…Furthermore, cases attended by CORPs did not decline as for the slide positivity rates, thus most of the fevers could possibly be due to other infections [27-30]. Studies conducted in this and other areas of north-eastern Tanzania have shown low slide positivity rates for malaria and bacterial infections among children with severe febrile illnesses, suggesting that the causes of most fevers are not clearly known [28-32] (and C Mahende, pers. comm.…”

Section: Discussionmentioning

confidence: 99%

Using community-owned resource persons to provide early diagnosis and treatment and estimate malaria burden at community level in north-eastern Tanzania

Rutta

Francis

Mmbando

et al. 2012

Malar J

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BackgroundAlthough early diagnosis and prompt treatment is an important strategy for control of malaria, using fever to initiate presumptive treatment with expensive artemisinin combination therapy is a major challenge; particularly in areas with declining burden of malaria. This study was conducted using community-owned resource persons (CORPs) to provide early diagnosis and treatment of malaria, and collect data for estimation of malaria burden in four villages of Korogwe district, north-eastern Tanzania.MethodsIn 2006, individuals with history of fever within 24 hours or fever (axillary temperature ≥37.5°C) at presentation were presumptively treated using sulphadoxine/pyrimethamine. Between 2007 and 2010, individuals aged five years and above, with positive rapid diagnostic tests (RDTs) were treated with artemether/lumefantrine (AL) while under-fives were treated irrespective of RDT results. Reduction in anti-malarial consumption was determined by comparing the number of cases that would have been presumptively treated and those that were actually treated based on RDTs results. Trends of malaria incidence and slide positivity rates were compared between lowlands and highlands.ResultsOf 15,729 cases attended, slide positivity rate was 20.4% and declined by >72.0% from 2008, reaching <10.0% from 2009 onwards; and the slide positivity rates were similar in lowlands and highlands from 2009 onwards. Cases with fever at presentation declined slightly, but remained at >40.0% in under-fives and >20.0% among individuals aged five years and above. With use of RDTs, cases treated with AL decreased from <58.0% in 2007 to <11.0% in 2010 and the numbers of adult courses saved were 3,284 and 1,591 in lowlands and highlands respectively. Malaria incidence declined consistently from 2008 onwards; and the highest incidence of malaria shifted from children aged <10 years to individuals aged 10–19 years from 2009.ConclusionsWith basic training, supervision and RDTs, CORPs successfully provided early diagnosis and treatment and reduced consumption of anti-malarials. Progressively declining malaria incidence and slide positivity rates suggest that all fever cases should be tested with RDTs before treatment. Data collected by CORPs was used to plan phase 1b MSP3 malaria vaccine trial and will be used for monitoring and evaluation of different health interventions. The current situation indicates that there is a remarkable changing pattern of malaria and these areas might be moving from control to pre-elimination levels.

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Prospective study on severe malaria among in-patients at Bombo regional hospital, Tanga, north-eastern Tanzania

Cited by 20 publications

References 43 publications

Severe Plasmodium falciparum and Plasmodium vivax malaria among adults at Kassala Hospital, eastern Sudan

Severe Plasmodium falciparum and Plasmodium vivax malaria among adults at Kassala Hospital, eastern Sudan

Complicated malaria and other severe febrile illness in a pediatric ward in Libreville, Gabon

Using community-owned resource persons to provide early diagnosis and treatment and estimate malaria burden at community level in north-eastern Tanzania

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