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Risk Factors for Mortality in Children Admitted for Suspected Malaria to a Pediatric Emergency Ward in a Low-Resource
Francesco Cavallin1, Luigi Pisani2, Lorenzo Stancari3
1Independent Statistician, Padova, Italy.
Insights
Malaria mortality in children is linked to severe conditions like cerebral malaria and malnutrition. Referral from peripheral units also increases risk, highlighting the need for improved healthcare resources and training.
Area of Science:
- Pediatric infectious diseases
- Global health epidemiology
- Clinical risk factor analysis
Background:
- Malaria remains a significant cause of mortality in pediatric populations, particularly in resource-limited settings.
- Identifying specific risk factors for mortality in children admitted with suspected malaria is crucial for targeted interventions.
Purpose of the Study:
- To determine the independent risk factors associated with mortality in children admitted to a pediatric emergency ward for suspected malaria in Sierra Leone.
Main Methods:
- A retrospective case-control study was conducted involving 320 pediatric patients (160 cases, 160 controls) admitted for suspected malaria between January 2015 and May 2016.
- Data collected included patient demographics, clinical presentation, comorbidities, treatments, and in-hospital events.
- Multivariable analysis was employed to identify independent predictors of mortality.
Main Results:
- Independent risk factors for mortality included referral from peripheral health units (OR, 4.00), cerebral malaria (OR, 6.28), malnutrition (OR, 3.14), dehydration (OR, 3.94), unresponsiveness to pain (OR, 2.17), and hepatosplenomegaly (OR, 3.20).
- Severe clinical conditions at admission and logistical challenges (indicated by referral status) significantly increased mortality risk.
Conclusions:
- Cerebral malaria, malnutrition, dehydration, and unresponsiveness are critical indicators of mortality risk in pediatric malaria cases.
- Improving healthcare logistics and resources at peripheral health units is essential to reduce mortality rates.
Objectives:
To identify the risk factors for mortality after admission for suspected malaria in a pediatric emergency ward in Sierra Leone.
Design:
Retrospective case-control.
Setting:
Pujehun Hospital Pediatric Ward in Pujehun, Sierra Leone.
Patients:
All cases were pediatric deaths after admission for suspected malaria at the Pujehun Hospital Pediatric Ward between January 1, 2015, and May 31, 2016. The case-control ratio was 1:1. The controls were infants admitted at Pujehun Hospital Pediatric Ward for malaria and discharged alive during the same period. Controls were selected as the next noncase infant admitted for malaria and discharged alive, as recorded in local medical records.
Interventions:
None.
Measurements And Main Results:
Children characteristics, vital variables on hospital access, comorbidity status at admission, antibiotic and antimalarial therapy at admission; presence of hematemesis, respiratory arrest or bradypnea, abrupt worsening, and emergency interventions during hospital stay; final diagnosis before discharge or death. In total, 320 subjects (160 cases and 160 controls) were included in the study. Multivariable analysis identified being referred from peripheral health units (odds ratio, 4.00; 95% CI, 1.98-8.43), cerebral malaria (odds ratio, 6.28; 95% CI, 2.19-21.47), malnutrition (odds ratio, 3.14; 95% CI, 1.45-7.15), dehydration (odds ratio, 3.94; 95% CI, 1.50-11.35), being unresponsive or responsive to pain (odds ratio, 2.17; 95% CI, 1.15-4.13), and hepatosplenomegaly (odds ratio, 3.20; 95% CI, 1.74-6.03) as independent risk factors for mortality.
Conclusions:
Risk factors for mortality in children with suspected malaria include cerebral malaria and severe clinical conditions at admission. Being referred from peripheral health units, as proxy of logistics issue, was also associated with increased risk of mortality. These findings suggest that appropriate interventions should focus on training and resources, including the increase of dedicated personnel and available equipment.
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