Evaluation of the Risk Factors and Prevalence of Cerebral Malaria in Children below 10 Years in Kiryandogo General Hospital.

Abstract

This study aimed at determining the prevalence and risk factors of cerebral malaria among children aged 10years and below in Kiryandogo General Hospital. The study was done in Kiryandogo General Hospital with target population of children diagnosed with cerebral malaria between February – December 2017 and constituted a sample size of 100 cases obtained using Kish and Leslie formula. The results were analyzed using descriptive method to calculate frequencies, proportions, means, measures of association and their 95% confidence intervals. Stepwise forward logistic regression was done for all variables that were significantly associated with cerebral malaria at the p=0.25 level on bivariate analysis to determine the independent factors associated with cerebral malaria. The results revealed that out of 100 cases that were enrolled into this study, the majority were male; 58.0% compared to females; 42.0%. the risk factors were found as follows; Caregiver factors associated with cerebral malaria among children were; having at least secondary education, being the mother of the child and female caregiver although not significant. Environmental factors that were significantly associated with Cerebral malaria were; staying in house under construction, staying in a house with open eaves or poorly covered windows, stagnant water within 10 meters from household and having received IRS 12 months preceding child's illness. Household related factors that were significantly protective of cerebral malaria were; sleeping under mosquito net every night and owning at least one ITN in the household. Patient related factors that were significantly associated with Cerebral malaria were; undernutrition and history of malaria illness. Health system factors that were significantly associated with Cerebral malaria among children were; distance between home and nearest health facility >10km, delayed diagnosis and having received antimalarial medicines at initial visit to a health facility. The study also revealed that children who were managed by a VHT were 1.53 times more likely to have cerebral malaria than those who were not. However, this finding was not statistically significant. A Stepwise forward logistic regression analysis revealed that patient related factors that were associated with mortality were; under nutrition and age <5 years. Caregiver healthcare seeking behavioural factors that were associated with mortality due to Cerebral malaria were; duration of child's symptoms before seeking medical care >2 days and first action taken was seeking medical care though not statistically significant. A bivariate analysis revealed the independent risk factors for Cerebral malaria as; distance >10km to the nearest health facility, duration of symptoms before seeking medical care >2 days, staying in a house under construction and duration of illness before receiving antimalarial medicines >24 hours. Owning at least one ITN in the household and having a mother as a caregiver were independent protective factors for cerebral malaria. The prevalence of cerebral malaria was high among children aged 5 years and below with the median age being 3 years. Most of the age group of children affected with cerebral malaria that died was 0-3 years. Keywords: prevalence, risk factors, cerebral malaria, children aged 10 years, under nutrition