Malaria in infants below six months of age: retrospective surveillance of hospital admission records in Blantyre, Malawi

Abstract

BackgroundInformation on the burden of malaria in early infancy is scarce. Young infants are relatively protected against clinical malaria during the first six months of life due to the presence of maternal antibodies and foetal haemoglobin, and have received relatively little attention with respect to research and treatment guidelines. The World Health Organization provides treatment guidelines for children from six months onwards, without specific treatment guidelines for the younger infants. A number of recent reports however suggest that the burden in this young age group may be underestimated.MethodsA retrospective review of paediatric hospital records at the Queen Elizabeth Central Hospital in Blantyre from 1998 to 2008 from three data sources was carried out. The number of admitted infants <6 months and ≤ 15 years was obtained from the registry books of the Paediatric-Nursery-Department and the Malaria Research Laboratory. For the period 2001 - 2004, more detailed malaria related admission information was available as part of an ongoing study on severe malaria, allowing a calculation of the proportion of infants < 6 months of age among admissions in children < 5 years.ResultsRetrospective analysis of hospital records showed that over the course of these years, the average annual proportion of paediatric admissions in children ≤ 15 years with confirmed malaria aged <6 months was 4.8% and ranged between 2.8%-6.7%. This proportion was stable throughout the seasons. Between 2001-2004, 9.9% of admissions with confirmed malaria in children <5 years occurred in infants <6 months, with numbers increasing steadily during the first six months of life.ConclusionsThese findings are consistent with recent reports suggesting that the burden of malaria during the six first months of life may be substantial, and highlight that more research is needed on dose-optimization, safety and efficacy of anti-malarials that are currently used off-label in this vulnerable patient group.

Congenital malaria: an overview

“…This is presumably because it is thought that infants under the age of six months are relatively protected against clinical malaria as a result of maternal antibodies transfer and the presence of foetal haemoglobin (Snow et al, 1998;Klein Klouwenberg et al, 2005;Duah et al, 2010). However, findings from a number of hospital-and community-based studies within sub-Saharan Africa suggest that the burden of malaria during the six first months of life may be substantial (Afolabi et al, 2001;Nweneka & Eneh 2004;Larru et al, 2009). Thus the burden of malaria among young children might be higher than what is generally estimated.…”

“…Reports from studies and reviews within the last few years are of the consensus that malaria causes at least 20% of all deaths in children under 5 years of age in sub-Saharan Africa (Rowe et al, 2006;Gyapong & Garshong, 2007;Hopkins et al, 2007;Sharp et al, 2007). However, it is pertinent to state that many of the reports presenting data on the burden of malaria among young children appear not to focus on infant specifically (Larru et al, 2009). This is presumably because it is thought that infants under the age of six months are relatively protected against clinical malaria as a result of maternal antibodies transfer and the presence of foetal haemoglobin (Snow et al, 1998;Klein Klouwenberg et al, 2005;Duah et al, 2010).…”

Clinical Presentation and Management of Neonatal Malaria: A Review

“…Despite these well-documented indirect effects of malaria to the fetus and newborn, the direct burden of neonatal malaria infection in terms of prevalence and outcome is not well described in malaria endemic areas. Studies published so far have documented contradictory levels of this burden [4][5][6][7]. Most of these studies were conducted in large referral or teaching hospitals, and the results are difficult to generalize [4][5][6]8,9].…”

“…Most of these studies were conducted in large referral or teaching hospitals, and the results are difficult to generalize [4][5][6]8,9]. Furthermore, many studies lack details of internal and external laboratory quality control procedures, parasite densities and examine a small sample size of neonates with malaria [6][7][8][9][10][11] and thus these limitations further complicate the interpretation and application of the findings. Neonates have different clinical manifestations [12,13] and lower parasite densities [14] than older children.…”

“…Thus, anti-malarials recommended are frequently used off-label, based on the recommended mg/kg dosing schedule for older children [7].…”