ABSTRACT
INTRODUCTION: This study aimed to determine the influence of the age and the level of malaria transmission on the clinical and biological expression of severe malaria in children. METHODS: A prospective descriptive study was conducted in nine referral hospitals in Kinshasa. A total of 1350 children, less than 15years old and hospitalized for severe malaria, were progressively included in the study between January and November 2011. RESULTS: The majority of these children (74.5%) were less than 5years of age. Major syndromes were severe anemia (11.4%), cerebral malaria (27.1%), and respiratory distress (20.5%). Severe anemia and cerebral malaria were associated with the age of the child and not the area transmission. On the other hand, respiratory distress was associated with high malaria transmission areas (P<0.05). After adjustment, these associations were maintained. High malaria lethality was observed in the group of children aged 12-59months (11.6%) and those from areas of high malaria transmission (8.4%). CONCLUSION: The child's age and level of transmission are associated with certain severe types of childhood malaria. Early and appropriate support would reduce the most fatal consequences associated with severe childhood malaria.
Subject(s)
Malaria/epidemiology , Malaria/transmission , Plasmodium vivax/isolation & purification , Adolescent , Age Distribution , Anemia/parasitology , Antimalarials/administration & dosage , Child , Child, Preschool , Democratic Republic of the Congo/epidemiology , Female , Humans , Infant , Infusion Pumps , Malaria/diagnosis , Malaria/drug therapy , Malaria/parasitology , Malaria, Falciparum/epidemiology , Malaria, Falciparum/transmission , Male , Plasmodium falciparum/isolation & purification , Prospective Studies , Quinine/administration & dosage , Risk Factors , Treatment OutcomeABSTRACT
BACKGROUND: Malaria is a major health problem in tropical Africa. In DRC, little is known about the characteristics of households of children with severe malaria or the factors associated with its lethality, especially relative to hospital status. METHODS: This study of 9 hospitals of the city-province of Kinshasa studied 1350 children younger than 15 years and hospitalized for severe malaria from January to November 2011. RESULTS: More than three quarters of children admitted to public (state) and church hospitals were from poor households and with uneducated mothers (P < 0.001). The case-fatality rate (5.9% of all children) differed according to hospital status: 5.3% in state hospitals, 8.4% in private hospitals, and 4.0% in the faith-based hospitals (P < 0.001). The risk of death was significantly associated with circulatory collapse (odds ratio, OR = 10.3), number of associated syndromes >2 (OR = 3.5), z-score of weight-for-age ≤-2 (OR = 3.5), delay in seeking medical care (OR = 4.9), body temperature ≥40°C (OR = 2.9), respiratory distress (OR = 1.9) and home rental (versus ownership) a tenant (OR = 2.8), and anorexia was a protective factor (odds ratio = 0.5). CONCLUSION: Severe cases of malaria are rife in poor households and periurban residential areas. Orienting prevention, control, and care- according to the vulnerability of affected households and providing early treatment are imperative if we are to reduce mortality from malaria.
Subject(s)
Hospitalization , Malaria/epidemiology , Adolescent , Adult , Body Temperature , Child , Child, Preschool , Democratic Republic of the Congo/epidemiology , Female , Hospital Mortality , Hospitals, Private , Hospitals, Religious , Hospitals, State , Humans , Infant , Literacy/statistics & numerical data , Male , Poverty/statistics & numerical data , Respiratory Insufficiency/mortality , Severity of Illness Index , Time-to-TreatmentABSTRACT
We describe two cases of neonatal meningitis due to Gram-negative bacilli treated successfully with ciprofloxacin. Examination of serial samples of cerebrospinal fluid indicated the effect of meningeal inflammation on penetration of this drug into the CSF.
