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Association between malaria control and paediatric blood transfusions in rural Zambia: an interrupted time-series
Alison B Comfort1, Janneke H van Dijk, Sungano Mharakurwa
1Abt Associates, International Health Division, Cambridge, MA, USA. alison_comfort@abtassoc.com.
Insights
Malaria control interventions significantly reduced paediatric blood transfusions by decreasing severe malarial anaemia admissions. This finding highlights the impact of malaria control on healthcare resource utilization, improving blood availability.
Area of Science:
- Public Health
- Epidemiology
- Pediatrics
Background:
- Severe malarial anaemia in children necessitates blood transfusions, yet evidence linking malaria incidence to transfusion rates is limited.
- This study investigates the correlation between paediatric malaria cases and blood transfusion demands.
Purpose of the Study:
- To quantify the relationship between paediatric malaria outpatient visits/admissions and paediatric blood transfusion use.
- To assess if malaria control interventions explain observed trends in paediatric blood transfusion utilization.
Main Methods:
- Utilized facility and patient records from a Zambian referral hospital and 13 rural health centres (2000-2008).
- Employed interrupted time series analysis with an autoregression-moving-average model to analyze data.
- Examined the temporal association between malaria control rollout and paediatric blood transfusion trends.
Main Results:
- Each additional paediatric malaria outpatient visit correlated with 0.07 additional paediatric blood transfusions (p < 0.05).
- Each paediatric admission for severe malarial anaemia correlated with 1.09 additional paediatric blood transfusions (p < 0.01).
- Paediatric blood transfusions decreased by 19.1 (50%) and 27.5 (72%) per month during intensified malaria control periods (2004-2006 and 2007-2008, respectively).
Conclusions:
- Paediatric admissions for severe malarial anaemia are the primary driver of paediatric blood transfusion use.
- The observed reduction in blood transfusions aligns with the implementation timeline of malaria control interventions.
- Effective malaria control can decrease the demand for paediatric blood transfusions, potentially improving blood supply availability in resource-limited settings.
Background:
Blood transfusions can reduce mortality among children with severe malarial anaemia, but there is limited evidence quantifying the relationship between paediatric malaria and blood transfusions. This study explores the extent to which the use of paediatric blood transfusions is affected by the number of paediatric malaria visits and admissions. It assesses whether the scale-up of malaria control interventions in a facility catchment area explains the use of paediatric blood transfusions.
Methods:
The study was conducted at a referral hospital for 13 rural health centres in rural Zambia. Data were used from facility and patient records covering all paediatric malaria admissions from 2000 to 2008. An interrupted time series analysis using an autoregression-moving-average model was conducted to assess the relationship between paediatric malaria outpatient visits and admissions and the use of paediatric blood transfusions. Further investigation explored whether the use of paediatric blood transfusions over time was consistent with the roll out of malaria control interventions in the hospital catchment area.
Results:
For each additional paediatric malaria outpatient visit, there were 0.07 additional paediatric blood transfusions (95% CI 0.01-0.13; p < 0.05). For each additional paediatric admission for severe malarial anaemia, there were 1.09 additional paediatric blood transfusions (95% CI 0.95-1.23; p < 0.01). There were 19.1 fewer paediatric blood transfusions per month during the 2004-2006 malaria control period (95% CI 12.1-26.0; p < 0.01), a 50% reduction compared to the preceding period when malaria control was relatively limited. During the 2007-2008 malaria control period, there were 27.5 fewer paediatric blood transfusions per month (95% CI 14.6-40.3; p < 0.01), representing a 72% decline compared to the period with limited malaria control.
Conclusions:
Paediatric admissions for severe malarial anaemia largely explain total use of paediatric blood transfusions. The reduction in paediatric blood transfusions is consistent with the timing of the malaria control interventions. Malaria control seems to influence the use of paediatric blood transfusions by reducing the number of paediatric admissions for severe malarial anaemia. Reduced use of blood transfusions could benefit other areas of the health system through greater blood availability, particularly where supply is limited.
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