Caractéristiques cliniques, biologiques et évolution des cas de paludisme de l'adulte hospitalisés en médécine interne à l'hôpital de zone de Come

Objectif: Décrire les signes et l'évolution du paludisme en médecine interne.Patients et méthodes : Etude transversale, descriptive sur 2 ans (1er janvier 2012 au 31 décembre 2013) en médecine interne de l'hôpital de Zone de Comè (Bénin). Etaient inclus, les patients chez qui le paludisme a été diagnostiqué en cours d'hospitalisation. Les données ont été analysées avec SPSS 18.0.Résultats : 45 cas de paludisme ont été diagnostiqués parmi les 317 cas de fièvre enregistrés pen-dant la période d'étude, soit 14,2%. La sex-ratio était de 0,88 et l'âge moyen de 36,69±13,76 ans. Les autres symptômes les plus fréquents étaient l'asthénie (55,6%), les vomissements (22,2%) et les cé-phalées (20,0%). 25 patients (55,6%) avaient au moins un critère de gravité ; 4,4% étaient décédés et 6,6% ont été transféré vers un niveau supérieur. Conclusion : Le paludisme est fréquent en Médecine. Promptement pris en charge, l'évolution est souvent favorable

Prescripción de antipalúdicos en hospitales centrales y provinciales de Angola / Antimalarials prescription in central and provincial hospitals in Angola

Introducción: La malaria constituye la primera causa de morbilidad y mortalidad en Angola y se desconocen las características de la prescripción de antipalúdicos en los hospitales. Objetivo: Caracterizar la prescripción de antipalúdicos en pacientes internados en hospitales centrales y provinciales de Angola. Método: Estudio de Utilización de Medicamentos, tipo indicación-prescripción, con elementos de esquema terapéutico. La muestra fue de 2 634 pacientes. La variable principal: evaluación de la prescripción, se operacionalizó como adecuada o no en función de la indicación, pauta terapéutica y contraindicaciones. Resultados: Predominó la malaria complicada (66,6 por ciento) y el sexo femenino en niños (51,7 por ciento) y adultos (51,0 por ciento). Se indicaron 4 518 prescripciones. La quinina endovenosa (20,4 por ciento) fue el tratamiento más utilizado en la malaria complicada y la quinina tabletas (26,5 por ciento) en la malaria simple. El 94,8 por ciento de las prescripciones no presentaron contraindicaciones, mientras que el 69,0 por ciento fueron adecuadas en su selección y el 65,1 por ciento en la pauta terapéutica. La evaluación de la prescripción resultó ser adecuada (55,0 por ciento). La malaria complicada presentó mayor número de prescripciones no adecuadas (47,5 por ciento). Conclusiones: Existe prescripción irracional de antipalúdicos, con mayor repercusión en la malaria complicada. Persiste una baja utilización de derivados de la artemisina, por lo que se incumple lo establecido en la Guía de Tratamiento de la Malaria(AU)

Introduction: The characteristics of the prescription of antimalarials in hospitals, where malaria is the first cause of mortality and morbidity, are unknown. Objective: To characterize the prescription of antimalarials in patients admitted to central and provincial hospitals in Angola. Methods: A Study of Drug's Use was made, type indication-prescription, with elements of a therapeutic scheme. The sample was of 2 634 patients. The main variable (evaluation of the prescription) was operationalized in adequate or not according to the indication, therapeutic guideline and contraindications. Absolute frequency and percentage were used as summary measures. Results: The most represented patients were adults (54.1 percent) and those admitted in general hospitals (82.6 percent). Complicated malaria was predominant (66.6 percent) and female sex in children (51.7 percent) and adults (51.0 percent). There were 4 518 prescriptions. Intravenous quinine (20.4 percent) was the most used treatment in complicated malaria and quinine tablets (26.5 percent) in simple malaria. 94.8 percent of the prescriptions had no contraindications, while 69.0 percent were adequate in their selection and 65.1 percent in the therapeutic regimen. The evaluation of the prescription was adequate (55.0 percent). Complicated malaria had a greater number of inappropriate prescriptions (47.5 percent). Conclusions: The existence of irrational prescription of antimalarials is evidenced with more repercussion in complicated malaria. There is still a low use of artemisinin derivatives, in breach of the Guide for Malaria's Treatment(AU)

Reacciones adversas por antipalúdicos en hospitales centrales y provinciales de Angola / Adverse reactions due to antimalarials in central and provincial hospitals in Angola

Introducción: El paludismo es la primera causa de morbilidad y mortalidad en Angola. Las particularidades de las reacciones adversas a antipalúdicos no están bien establecidas en pacientes hospitalizados. Objetivo: Caracterizar las reacciones adversas a medicamentos antipalúdicos. Método: Estudio de farmacovigilancia activa de serie de casos. El universo fueron 2 634 pacientes ingresados con paludismo confirmado en los hospitales centrales y provinciales de Angola durante el primer semestre de 2015. Médicos entrenados realizaron pesquisa diaria a través de interrogatorios farmacológicos, pases de visita y revisión de historias clínicas. Resultados: Hubo una tasa de 7,5 reacciones adversas por cada 100 pacientes internados. El 77,8 por ciento eran adultos y el 15,7 por ciento niños. Hubo predominio del sexo femenino en los niños y adultos (51,6 por ciento y 52,6 por ciento, respectivamente). Las reacciones más notificadas fueron las náuseas y vómitos (14,3 por ciento), el dolor abdominal (13,4 por ciento) y la erupción cutánea y los temblores, ambos con el 11,7 por ciento. La quinina endovenosa fue el antipalúdico de mayores reportes de reacciones adversas (29,0 por ciento). Además, las quininas (oral y endovenosa) provocaron el 41,1 por ciento del total de reacciones adversas encontradas. Predominaron las reacciones adversas leves (73,2 por ciento), las probables (47,6 por ciento) y las de aparición frecuentes (69,7 por ciento). Conclusiones: Existen reacciones adversas a los tratamientos antipalúdicos impuestos en los hospitales centrales y provinciales de Angola. Es importante la vigilancia activa en la identificación y el reporte de los efectos adversos por fármacos en los escenarios con sistema de farmacovigilancia que no alcanzan una implementación efectiva(AU)

Introduction: Malaria is the main cause of morbidity and mortality in Angola. Characteristics of adverse reactions due to antimalarials are not well established in hospitalized patients. Objective: Characterization of adverse reactions to antimalarial drugs. Method: An active pharmacovigilance study was carried out in a series of cases. There was a total of 2 634 patients admitted in central and provincial hospitals of Angola with confirmed malaria during the first semester of 2015. Trained doctors conducted daily screenings through pharmacological questionnaires, visits to the patients and reviews of medical records. Results: It was found that there was a rate of 7.5 adverse reactions per 100 hospitalized patients. 77.8 percent were adults and 15.7 percent were children. There was a predominance of females in children and adults (51.6 percent and 52.6 percent, respectively). The most commonly reported reactions were nausea and vomiting (14.3 percent), abdominal pain (13.4 percent) and rash and tremors both with 11.7 percent. Intravenous quinine was the antimalarial with the highest number of reports of adverse reactions (29.0 percent). In addition, oral and intravenous quinine caused 41.1 percent of the total number of ADRs found. Mild adverse reactions (73.2 percent), probable adverse reactions (47.6 percent) and frequent adverse reactions (69.7 percent) were predominant. Conclusions: Data provided by the study show the existence of adverse reactions to antimalarial treatments in central and provincial hospitals in Angola. It is highlighted the importance of an active surveillance in the identification and reporting of adverse effects due to drugs in scenarios with a pharmacovigilance system that does not reach an effective implementation(AU)

Influence des facteurs climatiques sur la morbidité palustre à Tillabéry au Niger

Problématique : La transmission du paludisme dans les pays du Sahel est tributaire des facteurs climatiques. Au Niger, il y a un gradient de transmission qui est décroissant du Sud au Nord. L'objectif de l'étude est de décrire les relations entre les facteurs climatiques et le paludisme afin de mettre au point des stratégies de contrôle. Patients et méthodes : Il s'agit d'une étude analytique et rétrospective, utilisant les données de 2004 à 2013 (10 ans) de la commune urbaine de Tillabéry. Les données sanitaires sur le paludisme sont issues du Système National d'Information Sanitaire (SNIS) du Niger. Les données climatologiques étaient celles de la Direction de la Météorologie Nationale (DMN). La méthode statistique utilisée est le coefficient de corrélation "r" entre les variables climatiques et morbi-mortalité palustre.Résultats : L'analyse univariée montre que le nombre de cas de paludisme le plus élevé était observé au mois de septembre et l'humidité relative minimale la plus élevée au mois d'aout. L'analyse multivariée fait ressortir une corrélation forte et positive entre l'humidité relative minimale et la mortalité (r = 0,719), puis la morbidité (r = 0,674). Par contre la température était négativement corrélée à la mortalité (r = -0,386) et à la morbidité palustre (r = -0,363).Conclusion : Il ressort de cette étude que l'humidité relative minimale et la pluviométrie ont un réel impact sur les pics de morbidité et de mortalité palustre, par opposition à la température. Le pic de morbi-mortalité intervient en septembre, un mois après les fortes pluviométries et humidités relatives minimales du mois d'aout. Ces observations serviront à la planification de la lutte anti larvaire, anti-vectorielle, de la chimio-prévention et de la prise en charge par les programmes nationaux de lutte contre le paludisme

Increase in cases of malaria in Mozambique, 2014: epidemic or new endemic pattern? / Aumento dos casos de malária em Moçambique, 2014: epidemia ou novo padrão de endemicidade?

ABSTRACT OBJECTIVE To describe the increase in cases of malaria in Mozambique. METHODS Cross-sectional study conducted in 2014, in Mozambique with national weekly epidemiological bulletin data. I analyzed the number of recorded cases in the 2009-2013 period, which led to the creation of an endemic channel using the quartile and C-Sum methods. Monthly incidence rates were calculated for the first half of 2014, making it possible to determine the pattern of endemicity. Months in which the incidence rates exceeded the third quartile or line C-sum were declared as epidemic months. RESULTS The provinces of Nampula, Zambezia, Sofala, and Inhambane accounted for 52.7% of all cases in the first half of 2014. Also during this period, the provinces of Nampula, Sofala and Tete were responsible for 54.9% of the deaths from malaria. The incidence rates of malaria in children, and in all ages, have showed patterns in the epidemic zone. For all ages, the incidence rate has peaked in April (2,573 cases/100,000 inhabitants). CONCLUSIONS The results suggest the occurrence of an epidemic pattern of malaria in the first half of 2014 in Mozambique. It is strategic to have a more accurate surveillance at all levels (central, provincial and district) to target prevention and control interventions in a timely manner.

RESUMO OBJECTIVO Descrever o aumento de casos de malária em Moçambique. MÉTODOS Estudo transversal conduzido em 2014, em Moçambique com dados do boletim epidemiológico semanal nacional. O número de casos registrados no período de 2009 a 2013 foi analisado e um canal endêmico foi criado usando o método de quartil e C-Sum. Taxas de incidência mensal foram calculadas para o primeiro semestre de 2014, permitindo determinar o padrão de endemicidade. Meses em que as taxas de incidência ultrapassaram o terceiro quartil ou a linha C-Sum foram declaradas como meses epidêmicos. RESULTADOS As províncias de Nampula, Zambézia, Sofala e Inhambane foram responsáveis por 52,7% de todos os casos no primeiro semestre de 2014. Também durante esse período, as províncias de Nampula, Sofala e Tete foram responsáveis por 54,9% das mortes por malária. As taxas de incidência da malária em crianças, e todas as idades, registaram padrões na zona de epidemia. Para todas as idades, a taxa de incidência registou um pico em abril (2.573 casos/100 mil habitantes). CONCLUSÕES Os resultados sugerem a ocorrência de um padrão epidêmico de malária no primeiro semestre de 2014 em Moçambique. É de importância estratégica haver vigilância mais acurada e em todos os níveis (distrital, provincial e central), para direccionar as intervenções de prevenção e controle em tempo útil.

association between development assistance for health and malaria, HIV and tuberculosis mortality: a cross-national analysis

Development assistance for health [DAH] and foreign aid have been criticized for being poorly associated with health and economic outcomes on a national level. This study is an attempt to examine whether DAH targeted specifically to malaria, HIV and tuberculosis [TB] is associated with changes in malaria, HIV and TB mortality, respectively. A dataset of DAH targeted to malaria, HIV and TB and corresponding malaria-, HIV- and TB-specific mortality was compiled for 120 low- and middle-income countries. Regression analysis was performed using country and time-period fixed effects and control variables. While malaria and HIV DAH were associated with reductions in malaria and HIV mortality, respectively, TB DAH was not significantly associated with reductions in TB mortality. Estimates were consistent in various sensitivity analyses, including generalized method of moments estimation, addition of extra controls and analysis of a multiply imputed dataset. In conclusion, targeted DAH is associated with reduction of HIV and malaria mortality on a national level

Diagnóstico molecular da malária vivax: precisão e sensibilidade / Diagnosis of vivax malaria: precision and sensitivity

O pronto diagnóstico das espécies plasmodiais para o tratamento correto e efetivo do paciente, impede a transmissão e a reintrodução da malária, assim como o agravamento do estado de saúde do paciente. A metodologia de PCR permite detectar e quantificar parasitos abaixo do limiar de detecção do diagnóstico microscópico. O método de PCR convencional para a detecção de P. vivax padronizado em nosso laboratório é eficaz na detecção da infecção,mas não permite o diagnóstico tão rápido e quantitativo como o da PCR no formato em tempo real assim como também não é conhecida a sua precisão,que compreende os parâmetros de repetibilidade e reprodutibilidade. Dessa forma, o nosso objetivo foi desenvolver um ensaio de PCR em tempo real com os sistemas SYBR Green e TaqMan para o diagnóstico da infecção malárica por P.vivax. O nosso desenho experimental compreendeu a construção da curva padrão com DNA de P.vivax, clonado ou não, para determinar alinearidade; o estabelecimento do limite inferior de detecção e da sensibilidade analítica para aferir a sensibilidade; e a variação intra ensaios (repetibilidade) e entre ensaios, entre operadores e entre equipamentos (reprodutibilidade) para definir a precisão. O desempenho desses parâmetros na padronização das reações de PCRs em tempo real revelou linearidade nos sistemas SYBR®Green e TaqMan®, respectivamente, de 4 x 104a 4 cópias/miL com o DNAclonado e de 1 x 104a 1 parasito/miL com amostra de P. vivax; o limite de quantificação de 1,77 e 0,94 e a sensibilidade analítica de 1,13 e 1,17cópias/miL...

The prompt diagnosis of plasmodial species for correct and effective patienttreatment prevents the transmission and reintroduction of malaria, as well asthe worsening of health condition of the patient. The PCR method allowsdetecting and quantifying parasites below the detection threshold of microscopicexamination. The in house conventional PCR method for P. vivax detectionstandardized in our laboratory is effective for detecting infection but does notallow the quantification and a diagnosis as fast as the as the real time PCRformat. Furthermore, its precision, comprising the repeatability andreproducibility parameters, is unknown. Thus, our aim was to develop a realtimePCR assay with SYBR Green and TaqMansystems for the diagnosis ofP. vivax malarial infection. Our experimental design included the construction ofa standard curve with P. vivax DNA, cloned or not, to determine linearity; thesetting of the lower detection limit and analytical sensitivity to measuresensitivity and; the intra assays variation (repeatability) and the oscillationsbetween assays, operators and equipment (reproducibility) to set precision. Theperformance of these parameters in the standardization of real time PCRshowed linearity in SYBR® Green and TaqMan®systems, respectively, from 4 x104to 4 copies/ L with cloned DNA and from 1 x 104to 1 parasite/ L withuncloned P. vivax DNA, quantification threshold of 1.77 and 0.94, and analyticalsensitivity of 1.13 and 1.17 copies/ L...

Mortalidad por paludismo en Colombia, 1979-2008 / Malaria mortality in Colombia, 1979-2008

Introducción. En Colombia, el paludismo representa un grave problema de salud pública. Se estima que, aproximadamente, 60 % de la población se encuentra en riesgo de enfermar o de morir por esta causa. Objetivo. Describir la tendencia de la mortalidad por paludismo en Colombia desde 1979 hasta 2008. Materiales y métodos. Se llevó a cabo un estudio descriptivo para determinar la tendencia de las tasas de mortalidad. Las fuentes de información fueron las bases de datos de las defunciones registradas y de las proyecciones de población de 1979 a 2008 del Departamento Nacional de Estadística (DANE). El indicador empleado fue la tasa de mortalidad. La tendencia se analizó mediante el software de análisis de regresión de puntos de inflexión (joinpoint). Resultados. Se certificaron 6.965 muertes por paludismo para una tasa ajustada por edad de 0,74 muertes por 100.000 habitantes para el periodo estudiado. En 74,3 % de las muertes, no se especificó la especie parasitaria. Las tasas de mortalidad por paludismo presentaron una tendencia decreciente estadísticamente significativa, que fue menor a partir de la segunda mitad de la década de los 90 en comparación con la presentada en la década de los 80. Conclusiones. La magnitud de la mortalidad por paludismo en Colombia no es grande, a pesar del evidente subregistro; se observó una tendencia descendente entre 1979 y 2008. La información derivada de los certificados de defunción, junto con la del sistema de vigilancia en salud pública, permitirá modificar las recomendaciones y mejorar la toma de medidas preventivas y de control pertinentes para continuar reduciendo la mortalidad causada por el paludismo.

Introduction. In Colombia, malaria represents a serious public health problem. It is estimated that approximately 60% of the population is at risk of the disease. Objective. To describe the mortality trends for malaria in Colombia, from 1979 to 2008. Materials and methods. A descriptive study to determine the trends of the malaria mortality was carried out. The information sources used were databases of registered deaths and population projections from 1979 to 2008 of the National Statistics Department. The indicator used was the mortality rate. The trend was analyzed by join point regression. Results. Six thousands nine hundred and sixty five deaths caused by malaria were certified for an age-adjusted rate of 0.74 deaths/100.000 inhabitants for the study period. In 74.3% of the deaths, the parasite species was not mentioned. The trend in the mortality rate showed a statistically significant decreasing behavior, which was lower from the second half of the nineties as compared with that presented in the eighties. Conclusions. The magnitude of mortality by malaria in Colombia is not high, in spite of the evident underreporting. A marked downward trend was observed between 1979 and 2008. The information obtained from death certificates, along with that of the public health surveillance system will allow to modify the recommendations and improve the implementation of preventive and control measures to further reduce the mortality caused by malaria.

Análisis de costo efectividad de la vitamina A en niños menores de 5 años en Colombia / Cost-effectiveness analysis (CEA) regarding vitamin A in children aged less than 5 years-old in Colombia

Objetivo evaluar la costo-efectividad relativa del uso de vitamina a en los niños menores de 5 años en la disminución de eventos de diarrea, malaria y la mortalidad, bajo la perspectiva del sistema de salud colombiano (SGSSS). Materiales y Métodos se construyó unárbol de decisión con muertes evitadas como desenlace. Las probabilidades se extrajeron de la literatura y los costos de fuentes oficiales. El umbral de costo-efectividad fue tres veces el producto interno bruto (PIB) per cápita colombiano de 2012. Se realizaron análisis de sensibilidad determinísticos, probabilísticos y curva de aceptabilidad. Resultados En una cohorte de cien mil niños, la administración de vitamina a, frente no hacerlo, representaría un ahorro en costos de atención médica de $ 340.306.917, debido a que reduce el número de eventos de diarrea (4.268) y de malaria (76), así como los casos en los que se requiere hospitalización. En todos los análisis de sensibilidad se obtuvo un ahorro para el sistema. Conclusión Dentro del sistema de salud colombiano, la suplementación con vitamina a para niños menores de 5 años, comparado con no hacerlo, es la estrategia menos costosa y más efectiva (dominante).

Objective Evaluating the relative cost-effectiveness of using vitamin A in children aged less than 5-years-old regarding the reduction of events involving diarrhoea, malaria and mortality from the Colombian health-related social security system (CHSSS). Materials and Methods A decision tree was constructed, using deaths averted as outcome. Probabilities were taken from the pertinent literature and costs from official sources. The cost-effectiveness threshold was three times greater than the per capita Colombian gross domestic product (GDP) in 2012. Probabilistic and deterministic sensitivity analyses were made and cost effectiveness acceptability curves were drawn. Results Providing a cohort of 100,000 children with vitamin A (as opposed to not doing so) would represent a saving regarding medical attention costs of $ 340,306,917 due to the number of events involving diarrhea (4,268) and malaria (76), having become reduced, as well as cases requiring hospitalization. A saving for the CHSSS was consistently obtained in sensitivity analysis. Conclusion Providing vitamin supplements for children aged less than 5 years-old would seem to be the least costly and most effective (dominant) strategy for the CHSSS, i.e. compared to not doing so).

Accuracy of an Immunochromatographic Diagnostic Test (ICT Malaria Combo Cassette Test) Compared to Microscopy among under Five-Year-Old Children when Diagnosing Malaria in Equatorial Guinea

Conventional malaria diagnosis based on microscopy raises serious difficulties in weak health systems. Cost-effective and sensitive rapid diagnostic tests have been recently proposed as alternatives to microscopy. In Equatorial Guinea; a study was conducted to assess the reliability of a rapid diagnostic test compared to microscopy. The study was designed in accordance with the directives of the Standards for Reporting Diagnostic Accuracy Initiative (STARD). Peripheral thick and thin films for the microscopy diagnosis and a rapid immunochromatographic test (ICT Malaria Combo Cassette Test) were performed on under five-year-old children with malaria suspicion. The ICT test detected Plasmodium spp. infection with a sensitivity of 81.5and a specificity of 81.9while P. falciparum diagnosis occurred with a sensitivity of 69.7and a specificity of 73.7. The sensitivity of the ICT test increased with higher parasitemias. The general results showed little concordance between the ICT test and microscopy (kappa = 0.28; se: 0.04). In Equatorial Guinea; the ICT Malaria Combo Cassette Test has proven to be an acceptable test to detect high P. falciparum parasitemias. However; the decrease of sensitivity at medium and low parasitemias hampers that ICT can replace properly performed microscopy at present in the diagnosis of malaria in children

Efficacy of Artesunate + Sulphadoxine-Pyrimethamine (AS + SP) and Amodiaquine + Sulphadoxine-Pyrimethamine (AQ+ SP) for Uncomplicated falciparum Malaria in Equatorial Guinea (Central Africa)

The objectives of the study were (i) to evaluate the efficacy of combination drugs; such as artesunate + sulphadoxinepyrimethamine (AS + SP) and amodiaquine + sulphadoxine-pyripethamine (AQ+ SP) in treatment of uncomplicated falciparum malaria (ii) to differentiate recrudescence from reinfection by analysing msp-1 and msp-2 genes of Plasmodium falciparum in treatment failure cases. Methods. We carried out an in vivo study in the year 2005 in 206 children between 6 to 59 months age groups. Of the 206; 120 received AQ+ SP; and 86 received AS + SP. A clinical and parasitological followup during 14 days was undertaken. Finger-prick blood sample from each patient was taken onWhatman filter paper (no. 3) on days 0; 7; 14 and also the day when the parasite and symptoms reappeared for PCR analysis. Results. Late treatment failure was observed in 3.5(4/114) with AQ+ SP; and 2.5(2/79) with AS + SP. The success rate was 96.5with AQ+ SP and 97.5with AS + SP. No deaths and severe reactions were recorded. Out of the 6 treatment failure cases; one was reinfection as observed by PCR analysis of msp-1 and msp-2 genes on day 14. Discussion. Both the combinations found to be efficacious and safe and could be used as a first-line treatment for uncomplicated falciparum malaria in Equatorial Guinea

audit of cases admitted in the children emergency ward in a Nigerian tertiary hospital

Knowledge of cause-specific morbidity and mortality is essential for understanding the overall epidemiological profile of disease in a population. The aim of this study was to audit the morbidity and mortality pattern of cases admitted into the children emergency ward of the University of Port Harcourt Teaching [UPTH], Port Harcourt, Nigeria. This was a prospective cross sectional study of children from one month to 16 years who were admitted into the children emergency ward of the UPTH from 1st January 2008 to 31[st] December 2008. Information collected included age, gender, presenting features, diagnosis, complications and outcome. Data collected was entered into a spread sheet using SPSS 15.0 for Windows statistical software which was also used for analysis. A total of 2,009 children comprising of 1,105 [55%] males and 904 [45%] females were admitted to the Children emergency during the study period. Common diagnoses, were malaria 452 [22.5%], diarrhoeal diseases 276 [13.7%] and bronchopneumonia 261[12.9%]. Fever, fast breathing, anaemia and convulsions were the most frequently documented clinical features. The overall mortality was 4.5%. More than 80% of the deaths occurred in children below the age of five years. Malaria and HIV infections were responsible for more than one third of the deaths in the emergency ward. Malaria, Diarhoeal diseases and HIV are important causes of childhood morbidity and mortality. There is need for effective control measures for prevention of these diseases

Caracterización de la mortalidad por malaria en el Valle del Cauca, 2005-2006 / Characterization of malaria mortality in Valle del Cauca, 2005-2006

Introducción. El Valle del Cauca es uno de los departamentos que mayor número de muertes por paludismo reporta en Colombia. El análisis de estas muertes permite una aproximación diagnóstica al funcionamiento del sistema de salud y contribuye a generar propuestas tendientes a disminuir la mortalidad por esta enfermedad. Objetivo. Caracterizar demográficamente y explorar posibles factores determinantes de muertes por malaria ocurridas en el Valle del Cauca. Materiales y métodos. Se hizo un análisis descriptivo de 25 de las 29 muertes por malaria identificadas en el Valle del Cauca entre 2005 y 2006. Resultados. El promedio de edad fue de 31,3 años (rango: 2 a 71), 11 fueron mujeres (una embarazada), 11 procedían de Buenaventura y 5 de los otros departamentos de la Costa Pacífica. Al ingreso a la primera consulta, no se ordenó gota gruesa o se solicitó tardíamente en 7 casos. En quienes se realizó gota gruesa en la primera consulta, 11 fueron reportados positivos y 5 negativos. La complicación más frecuentemente diagnosticada al ingreso al sitio de remisión fue paludismo cerebral (7/18), seguida de falla renal aguda (6/18). Después del ingreso, 13/18 individuos presentaron alguna otra complicación, principalmente edema agudo de pulmón (8/18) y choque (5/18). Conclusiones. Se identificaron fallas operativas en el cuidado primario de los pacientes con malaria. Esta información ha permitido implementar acciones de mejoramiento de la atención de las personas con malaria en el Valle del Cauca. Se espera que otros departamentos se unan a los esfuerzos para reducir la mortalidad por malaria en el país.

Introduction. Valle del Cauca is one of the states in Colombia that reports a high number of deaths due to malaria. Understanding the basis of malarial deaths is useful for assessing the efficacy of the health system and to identify areas where improvements are necessary to decrease malaria mortality. Objective. Potential determinants of mortality in malaria cases are characterized in a demographic study centered in Valle del Cauca. Materials and methods. A descriptive analysis was directed to 25 cases of malaria death occurring in Valle del Cauca during 2005 and 2006. Results. The mean age was 31.3 years (range, 2 to 71 yr), 11 were women (1 pregnant), 11 were from the malaria-endemic port of Buenaventura, and 5 from other Pacific coastal states. After entering the health system facility, the standard malaria diagnostic, the thick smear, was not ordered for 7 cases at any time during the treatment period. In cases where a thick smear was taken at first contact, 11 had a positive and 5 had a negative initial report. Cerebral malaria (7/18 cases) and renal failure (6/18 cases) were the most frequent complications. During hospitalization, 13/18 cases developed other complications, mainly acute lung edema (8/18 cases) and shock (5/18 cases). Conclusions. Failures in primary health care of patients with malaria were recognized. This information has been used to implement actions aimed at improving initial care of malaria subjects in the health services of Valle del Cauca. The study recommends that other states in Colombia increase their efforts to decrease malaria mortality.

Caregivers' Knowledge about Childhood Malaria in Gilgel Gibe Field Research Center; Southwest Ethiopia

Background: Malaria morbidity and mortality reduction in children greatly depends on caregivers' knowledge about childhood malaria. Objective: The objective of the study was to assess caregivers' knowledge about malaria in Gilgel Gibe Field Research Center; Southwest Ethiopia. Methods: A cross-sectional study was conducted from November to December 2005. A Sample of 588 households having children between the ages of 2-59 months were randomly selected from urban; semi-urban and rural strata proportional to their size. Caregivers of the children were interviewed using a structured questionnaire. Findings: Of 572 interviewed caregivers; most of them (70.1) spontaneously mentioned mosquitoes as the cause of malaria in children while half of them (51.9) had non-biomedical perceptions as causes of the disease. Among the symptoms of malaria in children; fever was mentioned spontaneously by most (86.2) of the caregivers. The three most commonly perceived preventive measures of malaria for children were cleaning the surrounding (43.7); keeping personal hygiene (35.7); and mosquito net usage (35). Urban or semi-urban residence; lower income and having formal education were found to be associated with good knowledge about childhood malaria. Conclusion: This study identified misperceptions regarding the cause and low level of awareness about childhood malaria among caregivers. These issues need to be addressed through tailored health promotion activities to prevent and control childhood malaria