A study to determine the morbidity and mortality patterns of malaria in children in a very low transmission setting

Abstract

Background: Despite several strides made to control malaria in Zambia, it still is endemic in many parts of the country and remains one of the leading causes of morbidity and mortality. Its epidemiology is characterised by varying transmission intensities which may bring about change in the patterns of malaria morbidity and mortality. Objective: To determine the patterns of malaria morbidity and mortality among children presenting to the University Teaching Hospital (UTH), Lusaka, Zambia, a very low malaria transmission zone. Method: The study was conducted between November 2014 and August 2015. Residents of Lusaka aged 0 - 15 years with MPS or RDT confirmed malaria were enrolled. Their data on demographic characteristics, clinical presentation, laboratory and treatment outcomes were collected using a questionnaire and entered into EpiData and transferred into STATA statistical package version 12 for analysis. Results: Total enrolled were 109 aged between 2 months to 15 years (median 5.6 years; inter quartile range [IQR] 3 – 8 years). The commonest symptom was fever at 94%. Proportions of uncomplicated and complicated malaria cases were 50.5% and 49.5%, respectively. History of travel was 54.6% among those with complicated and 45.4% with uncomplicated malaria. Infancy was not significantly associated with an increased risk of complicated malaria compared to ages 1-5years (OR 0.18, 95 CI: 0.02 – 1.67, p=0.13) and over 5 years (OR 0.18, 95 CI: 0.02 - 1.64, p=0.13). Children without history of travel were less likely to suffer from severe malarial anaemia compared to those who had (OR 1.65, 95 CI: 0.69 – 3.95, p=0.26). Infancy compared to ages 1-5 years (OR 0.64, 95 CI: 0.08 – 4.89, p=0.67) and above 5 years (OR 0.92, 95 CI: 0.13 – 6.38, p=0.93) and history of travel (OR 0.38, 95 CI: 0.12 – 1.25, p=0.17) were not significantly associated with increased risk of cerebral malaria. Four (3.7%) died, all without history of travel and all from cerebral malaria (CFR 21.1%). Conclusion: Severe malarial anaemia was the commonest pattern of severe disease. Mortality was unexpectedly low in this cohort of children. There is need for similar studies to be done periodically to monitor changes overtime.