Manifestations of Severe Malaria among the Under-five Children Attending Kampala International University Teaching Hospital, Bushenyi, Western Uganda: Pilot Study

Abstract

The clinical spectrum of severe malaria has not been described in Bushenyi, hence; this study was carried out to document the prevalence, major clinical features, contributing factors and immediate outcome of this number one killer disease of under-five children, at Kampala International University Teaching Hospital (KIUTH). This is a pilot study. Study design was retrospective; carried out in the records department of KIUTH; the study population were files of children, 5 years of age and below who attended KIUTH between August and October 2009, sample size was 100 using systematic random sampling. Ethical clearance and permission were obtained. Data was collected using checklist, entered into Epi-Info version 3.2 and analysed with SPSS 16 statistical software. Prevalence of complicated malaria was 29.8%. Male: female ratio was 1.33:1. Peak age was 3years, 78% of the children had no wasting and 62% slept under treated bed nets. The three most common presentations were febrile multiple convulsions (69%), hyperparasitemia (67%) and circulatory shock (59%), prolonged coma was the least presentation (30%). The infants most commonly present with severe anaemia (60%), while the older ones manifest usually with febrile multiple convulsions (76.9%). Mortality rate was 14%, higher in the malnourished (27.3%), boys (19.3%), age 5year bracket (23.1%), with hypoglycaemia (18.8%), respiratory distress (17.9%) and multiple febrile convulsions (17.4%). The prevalence and mortality from severe malaria was high. The most common presentations were multiple febrile convulsions, hyperparasitaemia and circulatory shock. Immediate outcome was significantly affected by the nutritional status. A larger study will be done in future for a more complete picture of this problem.

Pattern of malaria in hospitalized children in Khartoum state

“…In this study the risk of severe disease was significantly higher among patients with high compared to low-density parasitemia. This is consistent with reports in a previous study (72%), Uganda (67%) and India (61%) [3,12,14]. In some reports younger child had higher parasitemia, but we found no such age association.…”

“…This is consistent Similar with reports in North East India [14]. Symptoms and signs of malaria in our study were quite variable with convulsions and disturbed level of consciousness being the most common in severe disease which is comparable a previous and other reports [3,11,12]. Anemia (HB < 8 gm/dl) was detected in 55.6% of our children with malaria and in 61% of those with severe disease, which is similar to a previous report (62%) [3].…”

“…This pattern is often seen where endemicity is stable causing partial immunity in older children [15,16]. However, similar age pattern was reported in a previous study and studies in other countries where malaria transmission is also low and unstable [3,[11][12][13][14]. Our study was conducted in late rainy season and winter in which epidemics occur and this may explain our finding.…”

“…The remaining 14.8% (12/81) received multiple drug therapies before presenting to hospital. [11][12][13][14]. Factors influencing the severity of disease in malaria remained largely unexplained.…”

Epidemiological and clinical profile of paediatric malaria: a cross sectional study performed on febrile children in five epidemiological strata of malaria in Cameroon

“…The case fatality rate was however lower compared to the rate of 8.5% reported in Nigeria [55] and 14% reported in Uganda [54]. The case fatality rate reported in the current study may have been underestimated as some of the children might have died at home in the course of the study.…”