Severe malaria in children: A descriptive report from Kinshasa, the Democratic Republic of Congo

Kunuanunua, T.S.; Nsibu, Célestin Ndosimao; Bodi, Joseph M.; Tshibola, Thérèse K.; Bura, Mimy Makusi; Magoga, Kumbundu; Ekila, Mathilde Bothale; Situakibanza, Hippolyte; Aloni, Michel Ntetani

doi:10.1093/tropej/fmv029

Cited by 19 publications

(22 citation statements)

References 23 publications

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“…Our large retrospective study provides a contribution to the descriptions of paediatric BWF in malaria high transmission settings in Eastern Uganda. The prevalence rate of BWF of 13% reported in our study was comparable to earlier descriptions of BWF in malaria endemic settings (1,2,31,(39)(40)(41).…”

Section: Discussionsupporting

confidence: 91%

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Characterising Childhood Blackwater Fever and Its Clinical Care at Two Tertiary Hospitals in Eastern Uganda

Paasi¹,

Ndila²,

Okiror³

et al. 2021

Preprint

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Background In eastern Uganda, reports suggest that cases of Blackwater Fever (BWF) are on the rise. We summarise the base-line characteristics and routine care available to patients with BWF presenting at two tertiary hospitals in Eastern Uganda prior to the Phase I/II trial on use of paracetamol for acute kidney injury in children with BWF (PARIST; ISRCTN84974248). Methods This was a retrospective descriptive study for the period January – December 2018 for children admitted with a clinical diagnosis of BWF at Mbale and Soroti Regional Referral Hospitals in Eastern Uganda. Data on sociodemographic and clinical characteristics, routine in-patient care and outcomes were abstracted using a customised study proforma and analysed using STATA. Results We obtained 9578 admission records during the study period, of which 1241 (13.0%) were admitted with a diagnosis of BWF. The median age was 60 months (IQR 36–90). Male: female ratio was 1.5:1. More cases of BWF 682/1241 (55.0%) were in children > 5 years compared to 559/1241 (45.0%) ≤ 5 years [95% CI (0.41–0.59); P = 0.0002]. The common symptoms included fever 1109/1241 (89.4%), vomiting 599/1241 (48.3%) and abdominal pain 494/1241 (39.8%). Conversely, the common signs recorded were clinical pallor 742/1241 (59.8%), clinical jaundice 369/1241 (29.7%), fever 332/1241 (26.7%) and prostration 231/1241 (18.6%). In addition, abdominal tenderness was documented in 120/1241 (9.7%), splenomegaly in 122/1241 (9.8%) and hepatomegaly in 86/1241 (6.9%). Case records with BWF were more in the second half of the year with a peak in the months of July and September. 510/1241 (41.1%) were treated with antimalarial drugs mainly parenteral Artesunate 501/510 (98.2%). 660/1241(53.2%) of the patients were managed with antibiotics mainly parenteral ceftriaxone 616/660 (93.3%). There were 426/1241 (34.3%) patients who received blood transfusion during admission. Clinicians used steroid treatment in 388/1241 (31.3%), mainly parenteral hydrocortisone 370/388 (95.4%). Conclusions BWF accounted for 13% paediatric hospital admissions in the region. It was predominant in children > 5 years of age. It typically presents with passing dark urine, fever, abdominal pain, clinical jaundice and pallor. Locally there are no treatment guidelines for BWF. These data provide background data useful for future studies on BWF in the region.

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Section: Discussionsupporting

confidence: 91%

“…Since then, however, use of such case de nitions in the African populations have been done with mixed outcomes across geographical or population strata. For instance, prevalence and mortality range from 6-59% (11-14) and 4.4-25.3% (15)(16)(17) respectively. BWF studies in African children are complex (7,11,18).…”

Section: Introductionmentioning

confidence: 99%

Characterising Childhood Blackwater Fever and Its Clinical Care at Two Tertiary Hospitals in Eastern Uganda

Paasi¹,

Ndila²,

Okiror³

et al. 2021

Preprint

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“…Of note, however, cases with BWF in our current series were significantly older than controls presenting without BWF (Supplementary Figure 1), an observation consistent with the hypothesis, previously proposed [ 24 ], that BWF in children might result from recurrent historic exposure to antimalarial drugs. In a series of 378 children with severe malaria in Kinshasa, DRC, a city with holoendemic malaria, 25% of cases had BWF, of which 79% reported recent treatment with oral quinine and 6% had been treated with artemisinin-based combination therapies (ACTs) [ 22 ]. The authors suggested that the limited availability and higher cost of ACTs meant that quinine was being used increasingly as first-line treatment in uncomplicated malaria cases [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

High Frequency of Blackwater Fever Among Children Presenting to Hospital With Severe Febrile Illnesses in Eastern Uganda

Engoru

Uyoga

Muhindo

et al. 2017

Clinical Infectious Diseases

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“…Malaria-related morbidity and mortality are common in children under five years from Africa where malaria transmission rate is relatively high [1]. In Ghana, malaria is major cause of mortality and morbidity, particularly among children under five years [2].…”

Section: Introductionmentioning

confidence: 99%

Qualitative and Quantitative Microbiological Studies of Paediatric Artemether-Lumefantrine Dry Powders and Paracetamol Syrups Obtained from Selected Drug Stores in Accra, Ghana

Opoku¹,

Nyanor

2019

Journal of Tropical Medicine

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Infants and children under five years generally have high susceptibility to pathogenic and opportunistic infections due to immaturity and inexperience of their immune responses. The lives of these young children are threatened when they consume pharmaceutical preparations of poor microbiological quality. Considering the widespread use of artemether-lumefantrine dry powder and paracetamol syrup among the general population in Ghana, there is a need to investigate the microbiological quality and safety of these paediatric pharmaceutical preparations. The study investigated the microbiological quality of 180 samples comprising 90 artemether-lumefantrine dry powders and 90 paracetamol syrups. The samples were tested for presence of specified indicator pathogens, Total Aerobic Microbial Count (TAMC), and Total Yeasts and Moulds Count (TYMC) using compendial procedures. Results from the study indicated that 16 (17.78%) of the paracetamol syrup samples showed bioburden levels above United States Pharmacopeia (USP) maximum acceptable limit, but none of the artemether-lumefantrine dry powder samples recorded microbial load above the limit of USP. Four samples of paracetamol syrup and 4 samples of artemether-lumefantrine dry powder showed presence of P. aeruginosa, whereas 5 samples of paracetamol syrup were found to be contaminated with Salmonella spp. Overall, 4.44% of the artemether-lumefantrine dry powders and 25.56% of the paracetamol syrups were found to be noncompliant with USP specifications for nonsterile pharmaceutical preparations for oral use. This study has revealed the existence of substandard paediatric pharmaceutical products in the Ghanaian market, hence the need for regulatory bodies to intensify monitoring and postmarketing surveillance programmes to help get rid of these products from the market.

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Severe malaria in children: A descriptive report from Kinshasa, the Democratic Republic of Congo

Cited by 19 publications

References 23 publications

Characterising Childhood Blackwater Fever and Its Clinical Care at Two Tertiary Hospitals in Eastern Uganda

Characterising Childhood Blackwater Fever and Its Clinical Care at Two Tertiary Hospitals in Eastern Uganda

High Frequency of Blackwater Fever Among Children Presenting to Hospital With Severe Febrile Illnesses in Eastern Uganda

Qualitative and Quantitative Microbiological Studies of Paediatric Artemether-Lumefantrine Dry Powders and Paracetamol Syrups Obtained from Selected Drug Stores in Accra, Ghana

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