Malaria in patients with sickle cell anaemia: burden, risk factors and outcome at the Laquintinie hospital, Cameroon.
Eleonore NLE; Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon.
Cumber SN; Institute of Medicine, Department of Public Health and Community Medicine (EPSO), University of Gothenburg, Box 414, SE - 405 30, Gothenburg, Sweden.; Faculty of Health Sciences, University of the Free State, Bloemfontein, 9301, South Africa.; School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Private Bag X323, GezinaPretoria, 0001, Pretoria, South Africa.
Charlotte EE; Faculty of Medicine and Pharmaceutical sciences, Douala, Cameroon.; Pediatric Department, Laquintinie Hospital Douala, Douala, Cameroon.
Lucas EE; Pediatric Department, Laquintinie Hospital Douala, Douala, Cameroon.
Edgar MML; Faculty of Health Sciences, University of Buea, Buea, Cameroon.
Nkfusai CN; Cameroon Baptist Convention Health Services, Bamenda, Cameroon. .
Geh MM; Faculty of Health Sciences, University of Buea, Buea, Cameroon.; St Mary Soledad Catholic Hospital Bamenda, Bamenda, Cameroon.
Ngenge BM; Faculty of Health Sciences, University of Buea, Buea, Cameroon.; Etougebe Baptist Hospital, Yaounde, Cameroon.
Bede F; Cameroon Baptist Convention Health Services, Bamenda, Cameroon.
Fomukong NH; Faculty of Health Sciences, University of Buea, Buea, Cameroon.
Kamga HLF; Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon.
Mbanya D; Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon.
BMC infectious diseases [BMC Infect Dis] 2020 Jan 14; Vol. 20 (1), pp. 40. Date of Electronic Publication: 2020 Jan 14.
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Original Publication: London : BioMed Central, [2001-
MeSH Terms :
Plasmodium falciparum/*isolation & purification
Sickle Cell Trait/*epidemiology
Sickle Cell Trait/*parasitology
Adolescent ; Antimalarials/therapeutic use ; Cameroon/epidemiology ; Child ; Child, Preschool ; Comorbidity ; Female ; Hospitalization ; Hospitals ; Humans ; Infant ; Male ; Pre-Exposure Prophylaxis ; Prevalence ; Retrospective Studies ; Risk Factors ; Sickle Cell Trait/mortality ; Sickle Cell Trait/prevention & control
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Keywords: Malaria in patients with sickle cell anaemia: burden; Risk factors and outcome at the laquitinie hospital
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Date Created: 20200116 Date Completed: 20200406 Latest Revision: 20200408
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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.
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