PREVALENCE OF PAIN, ITS CHARACTERISTICS AND CORRELATES AMONG OUTPATIENTS PRESENTING WITH MALARIA TO OUTPATIENT CLINICS IN IBADAN, NIGERIA

Abstract

Malaria still exert tremendous burden on the inhabitants of sub-Sahara Africa in spite of numerous control measures. The burden is attributable to its high morbidity (resulting from the acute onset of fever, pains including headache, rapid progression and debilitation) and mortality. Although, pain is one of the commonest reasons why patients suffering from malaria seek medical attention yet, the pain due to malaria is largely ignored, poorly evaluated and virtually un-studied. This pilot study explored pain due to malaria among outpatients in Ibadan, south-west Nigeria to determine its prevalence, characteristics and correlates. This was a hospital-based, two-centre, cross-sectional survey conducted in Ibadan. Outpatients, aged six years or more, clinically diagnosed of acute uncomplicated malaria were enrolled consecutively over a three-month period. Seven hundred consenting enrollees were evaluated for the presence, quality, intensity and perceived effects of malaria pains using structured, interviewer administered questionnaires. Pain intensity was measured with category pain rating scales for adults (≥12years) and the Wong-Baker faces scale for children (<12years) where, pain was rated as mild, moderate, severe and worst imaginable. Descriptive statistics such as means ± standard deviations and proportions were used to summarize quantitative and qualitative variables, respectively. The x2 test was used to investigate bivariate association between two qualitative variables at 5% level of significance while, logistic regression model of covariates and factors was used to determine the risk of occurrence of malaria pain. Six hundred and sixty-eight questionnaires were returned suitably completed and were analysed. The mean age of respondents was 33.0 years (SD 16.1), range (6-81 years), 12.7% were children under 12 years, 66.6% were females and 72.3% had malaria pain. The head (66.0% vs. 72.8%), general muscular sites (17.0% vs. 39.5%), abdomen (37.7% vs. 11.4%) and joints (5.7% vs. 17.0%) were the most common location of malaria pain among children versus adults, respectively. The character of malaria pain was aching in 90.6% vs. 91.9% and intermittent in 64.7% vs. 71.2% among adults versus children, respectively. The pain at worst was reported as mild, moderate and severe by 28.6%, 47.2% and 23.4%, respectively; while 0.8% had worst pain imaginable. The pain was severe enough to completely interrupt work or school activities in 4.3% of respondents. Respondents' sex (p=0.003), age (p=0.028), PCV level (p=0.005), use of any antimalarial (p=0.009) or use of a potent ACTs (p=0.002) were significantly associated with having malaria pain. This study highlighted pain as a significant contributor to the burden of malaria and did show that being a child or male or having PCV<30% or not using ACTs early increased the risk of developing malaria pain. More attention needs to be paid to the understanding of the pathophysiology of pain, its course and treatment in malaria patients. Malaria control efforts should consider incorporating accurate pain evaluation and treatment into management protocols in order to minimize the impact of this disease that takes its heaviest toll on the most impoverished corners of our planet.