Severe and uncomplicated falciparum malaria in children from three regions and three ethnic groups in Cameroon: prospective study

Abstract

BackgroundTo identify the factors that account for differences in clinical outcomes of malaria as well as its relationship with ethnicity, transmission intensity and parasite density.MethodsA prospective study was conducted in nine health facilities in the Centre, Littoral and South West regions of Cameroon, and in three ethnic groups; the Bantu, Semi-Bantu and Foulbe. Children aged one month to 13 years, with diagnosis suggestive of malaria, were recruited and characterized using the WHO definition for severe and uncomplicated malaria. Malaria parasitaemia was determined by light microscopy, haematological analysis using an automated haematology analyser and glucose level by colorimetric technique.ResultsOf the febrile children screened, 971 of the febrile children screened fulfilled the inclusion criteria for specific malaria clinical phenotypes. Forty-nine (9.2%) children had cerebral malaria, a feature that was similar across age groups, ethnicity and gender but lower (P < 0.004) in proportion in the Centre (3.1%, 5/163) compared to the Littoral (11.3%, 32/284) and South West (13.6%, 12/88) regions. Severe anaemia was the most frequent severe disease manifestation, 28.0% (248/885), which was similar in proportion across the three ethnic groups but was more prevalent in females, less than 60 months old, and the Centre region. About 20% (53/267) of the participants presented with respiratory distress, a clinical phenotype independent of age, gender and ethnicity, but highest (P < 0.001) in the Centre (55%, 11/20) compared to the Littoral (27.3%, 3/11) and South West (16.5%, 39/236) regions. Uncomplicated malaria constituted 27.7% (255/920) of hospital admissions and was similar in proportion with gender and across the three ethnic groups but more prevalent in older children (≥ 60 months) as well as in the South West region. The density of malaria parasitaemia was generally similar across clinical groups, gender and ethnicity. However, younger children and residents of the Centre region carried significantly higher parasite loads, with the burden heavier in the Semi-Bantu compared to their Bantu (P = 0.009) and Foulbe (P = 0.026) counterparts in the Centre region. The overall study case fatality was 4.8 (47/755), with cerebral malaria being the only significant risk factor associated with death. Severe anaemia, though a common and major clinical presentation, was not significantly associated with risk of death.ConclusionAbout half of the acutely febrile children presented with severe malaria, the majority being cases of severe malaria anaemia, followed by respiratory distress and cerebral malaria. The latter two were less prevalent in the Centre region compared to the other regions. Cerebral malaria and hyperpyrexia were the only significant risk factors associated with death.

Malaria, Moderate to Severe Anaemia, and Malarial Anaemia in Children at Presentation to Hospital in the Mount Cameroon Area: A Cross-Sectional Study

“…However, in order to properly evaluate control measures, regular updates of disease morbidities in public health services and community settings in the country are invaluable. Even though studies have been carried out on severe and uncomplicated malaria in children admitted to hospitals in different parts of the country [2, 3] as well as uncomplicated and asymptomatic malaria in the communities [4] and primary school children [5], there is a dearth of information on malaria-related morbidities at presentation in the general medical outpatient department in the country.…”

“…While malaria is one of the factors that contributes to the public health problem of anaemia in children in Cameroon [2, 6, 7], in almost all countries in Sub-Saharan Africa, anaemia is a moderate or severe public health problem causing significant morbidity and mortality [8]. Much of the burden of infections operates through the mechanism of anaemia which is characterized by a reduction in haemoglobin concentration causing impairment in meeting the oxygen demands of the body.…”

“…Severe MA is one of the main clinical presentations of severe malaria caused by P. falciparum [2]. The aetiology of severe MA in malaria endemic areas may include a number of discrete as well as overlapping features, such as lysis of infected and uninfected RBCs [13], splenic sequestration of RBCs [14], dyserythropoiesis and bone marrow suppression [15], infectious diseases, and chronic transmission of malaria.…”

Insertion/deletion gene variants of angiotensin converting enzyme do not predispose cameroonians of the Bantu ethnic group to essential hypertension

“…Therefore, identification of these EHsusceptible genes is potentially useful to elucidate the complex genetic mechanisms of the disease. This would allow for earlier screening and diagnosis of high-risk individuals, preventing disease progression through early lifestyle changes and pharmacological treatment (Quenum et al, 2014) thus contributing to a reduction of complications and incidence of EH Cameroon is made up of 10 Regions with over 240 tribes distributed in three main ethnic groups: Bantu (Center, South, East, Southwest and Littoral regions), Semi-Bantu (North West and West regions) and Fulbes (Adamawa, Far North and North regions) (Achidi et al, 2012). The present study was undertaken to determine the association between ACE I/D gene polymorphism and EH among the Bantu ethnic population in Buea, South West Region of Cameroon.…”

Association between the MTHFR C677T gene polymorphism and essential hypertension in South West Cameroon

“…Cameroon is made up of 10 regions, grouped into three main ethnic groups: Bantus (South West, Center, South and Littoral regions), semi-Bantu (North West and West regions) and Fulbe (Adamawa, East, Far North and North regions) (Achidi et al, 2012). Intermarriage between the different ethnic groups is limited by culture, traditional beliefs, and dialect.…”