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Increasing burden of childhood severe malaria in a Nigerian tertiary hospital: implication for control
Adebola Emmanuel Orimadegun1, Olufunmi Fawole, James Okorie Okereke
1Department of Paediatrics, University College Hospital, Ibadan, Nigeria. beorimadegun@yahoo.com
Insights
Severe malaria significantly impacts Nigerian children, especially those under five, with increasing hospitalizations and a high fatality rate. Severe malarial anemia is a major concern, necessitating a review of current malaria control strategies.
Area of Science:
- Public Health
- Pediatrics
- Infectious Diseases
Background:
- Malaria is a significant public health issue in Nigeria, disproportionately affecting child and maternal health.
- The burden of severe malaria among Nigerian children has been underreported, hindering effective strategy evaluation.
Purpose of the Study:
- To document the hospital burden of severe malaria in children admitted to the University College Hospital, Ibadan.
- To inform the impact and health implications of current malaria control strategies in Nigeria.
Main Methods:
- Retrospective review of 6-year case records (2000-2005) of children admitted to the emergency ward.
- Severe malaria cases defined by confirmed parasitaemia (blood film microscopy) and WHO criteria.
Main Results:
- Severe malaria accounted for 11.3% of pediatric admissions, with 89.1% in children under five.
- The yearly proportional morbidity rate increased significantly from 2000 to 2004 (P < 0.001).
- Severe malarial anemia was more common than cerebral malaria and associated with high mortality (9.6% case fatality rate).
Conclusions:
- There is an increasing trend in severe malaria morbidity among hospitalized Nigerian children.
- Factors associated with malaria deaths include wasting, young age, hypoglycemia, and respiratory distress.
- Current malaria control strategies in Nigeria may require review due to the persistent high burden of severe malaria.
Abstract:
Malaria remains an important public heath concern in Nigeria because of its impact on child and maternal health, but the contribution of severe malaria to morbidity among Nigerian children was scantly reported. This study was undertaking to document the hospital-burden of severe malaria among children in Ibadan in order to reflect on the impacts and health implications of the current malaria control strategies. A review of 6-year case records of all children admitted to the emergency ward of the University College Hospital Ibadan was carried out. Cases of severe malaria were defined as those children in whom parasitaemia were confirmed with blood film microscopy and any of the WHO case definitions for severe malaria was documented. Severe malaria cases constituted 11.3% of 16 031 admissions (2000-05) with 89.1% being children <5 years old. Cerebral malaria accounted for about one-fifth (19.7%) of all severe malaria cases. The yearly proportional morbidity rate from severe malaria ranged from 8.7% to 13.2% with significant increase from 2000 to 2004 (X2 = 48.49; df = 5; P < 0.001). Severe malaria accounted for 12.4% of all paediatric deaths with an estimated overall case fatality rate of 9.6%. Deaths from malaria were significantly associated with wasting (Z-score for weight-for-height
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