Risk Factors for Mortality in Children Hospitalized with Severe Malaria in Northern Zambia: A Retrospective Case-Control Study

Abstract

Abstract.Malaria remains a public health crisis in areas where it has resisted control efforts. In Nchelenge District, a high-transmission area in northern Zambia, malaria accounts for more than one-third of pediatric hospitalizations and nearly one-half of hospital deaths in children. To identify risk factors for death due to malaria, we conducted a retrospective, time-matched case-control study of 126 children hospitalized with malaria who died (cases) and 126 children who survived (controls). There were no differences in age, gender, hemoglobin concentration, or prevalence of severe anemia between cases and controls. Children who died were more likely to come from villages located at greater distances from the hospital than children who survived (median 13.5 versus 3.2 km). Each additional kilometer of distance from the hospital increased the odds of death by 4% (odds ratio 1.04, 95% confidence interval 1.01–1.07, P < 0.01). Extent of anemia and admission during periods when blood was unavailable for transfusion were associated with early death (P ≤ 0.03). Delays in initiation of treatment of severe malaria contribute to the increased odds of death in children referred from more distant health centers, and might be mitigated by transportation improvements, capacity at rural health posts to administer treatment before transfer, hospital triage systems that minimize time to treatment, and reliable blood product stores at referral hospitals.

House Structure Is Associated with Malaria among Febrile Patients in a High-Transmission Region of Zambia

“…67 The absence of a protective effect of IRS is consistent with a contemporaneous report of only marginal impact of IRS on malaria in the study area, and echoes findings of the landmark Garki Project. 40,68 Outdoor transmission, incomplete spray coverage in the community, inaccurate timing of IRS in relation to malaria vector density, poor residual efficacy, or mosquito resting behaviors that avoid sprayed surfaces are among factors that could explain its low efficacy in this setting. Similarly, ITN use was not significantly associated with malaria in our sample.…”

“…39 Malaria continues to account for upward of 30-40% of admissions to the children's ward and 40% of pediatric in-hospital deaths. 40 Study participants. Participants were pediatric and adult patients presenting with acute febrile illness.…”

Bridging the quality gap in diagnosis and treatment of malaria

“…A delay in seeking care for fever is not uncommon in endemic settings,4 and a missed diagnosis of malaria when a patient enters the health system can lead to an uncomplicated case becoming severe. Appropriate treatment or referral in these cases may be delayed or non-existent,5 contributing to an increased likelihood of morbidity and death.…”

Projected health impact of post-discharge malaria chemoprevention among children with severe malarial anaemia in Africa

“…P. falciparum malaria causes anaemia by triggering severe haemolysis of erythrocytes and suppression of erythropoiesis. 1 In highly endemic areas, around one-third of all hospitalised children may be severely anaemic (Hb<5g/dL) 2,3 and severe anaemia may contribute to around half of all malaria-attributed deaths. 4 While malaria transmission has declined in many countries in the past two decades, highly endemic conditions persist in parts of sub-Saharan Africa.…”