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Malaria in patients with sickle cell anaemia: burden, risk factors and outcome at the Laquintinie hospital, Cameroon.
BMC Infectious Diseases ( IF 3.7 ) Pub Date : 2020-01-14 , DOI: 10.1186/s12879-019-4757-x
Ngo Linwa Esther Eleonore 1 , Samuel Nambile Cumber 2, 3, 4 , Eposse Ekoube Charlotte 5, 6 , Esuh Esong Lucas 6 , Mandeng Ma Linwa Edgar 7 , Claude Ngwayu Nkfusai 8 , Meh Martin Geh 7, 9 , Budzi Michael Ngenge 7, 10 , Fala Bede 8 , Nzozone Henry Fomukong 7 , Henri Lucien Fouammo Kamga 1 , Dora Mbanya 1
Affiliation  

BACKGROUND It is believed that the current prevalence of malaria in endemic areas reflects selection for the carrier form of sickle cell trait through a survival advantage. Malaria has been incriminated as a great cause of mortality in people with sickle cell disease (SCD). However, people with SCD, a high-risk group, do not benefit from free or subsisized malaria prevention and treatment in Cameroon unlike other vulnerable groups which may be due to insufficient evidence to guide policy makers. This study aimed at describing clinical and socio-demographic characteristics of patients with malaria, determining the prevalence of malaria in hospitalized children and in those with SCD and without, compare frequency of presentation of malaria related complications (using clinical and laboratory elements that define severe malaria) between children admitted for malaria with SCD and those without and finally, determing the risk factors for death in children admitted for malaria. METHODS This was a retrospective analysis of admission records of children age 1 to 18 years with a confirmed malaria diagnosis admitted at the Laquintinie Hospital during January 2015 through December 2018. Clinical features, laboratory characteristics and outcome of malarial infections, stratified by SCD status were studied. Patients with HIV infection, malnutrition, renal failure and discharged against medical advice were excluded from the study. Data were analysed using Epi-info 7 software and analysis done. Chi square test, Odds ratios, CI and student's t test were used to determine association between variables. Statistical significance was set at p-value ≤0.05. RESULTS The prevalence of malaria was lower among children with SCD than it was among children without SCD (23.5% vs 44.9%). Similarly, among those with a positive microscopy, the mean parasite density was significantly lower among children with SCD than it was among children without SCD (22,875.6 vs 57,053.6 parasites/ μl with t-value - 3.2, p-value 0.002). The mean hemoglobin concentration was lower in SCD as compared to non SCD (5.7 g/l vs 7.4 g/l, t-value - 12.5, p-value < 0.001). Overall mortality in SCD was 3.4% and malaria was reponsible for 20.4% of these deaths as compared to the 35.4% in non SCD patients. Convulsion and impaired consciousness were significantly lower in SCD group (OR:0.1, CI: 0.1-0.3, p value < 0.01 and OR:0.1, CI:0.1-0.2, p-value < 0.001 respectively). Death was significantly higher in SCD patients with malaria as compared to SCD patients admitted for other pathologies (3.2% vs 1.5%., OR:2.2, CI:1-5, p-value 0.050). CONCLUSION The SCD population has a lower mortality related to malaria compared to the non-SCD population. Meanwhile, within the SCD population, those admitted with malaria are twice more likely to die than those admitted for other pathologies. Jaundice, hepatomegaly and splenomegaly were common in SCD with malaria, however no risk factors for malaria severity or malaria related death was identified.

中文翻译:

镰状细胞性贫血患者的疟疾:喀麦隆拉昆蒂尼医院的负担、危险因素和结果。

背景技术据信当前疟疾在流行地区的流行反映了通过生存优势对镰状细胞性状载体形式的选择。疟疾已被认为是镰状细胞病 (SCD) 患者死亡的主要原因。然而,与其他弱势群体不同,SCD 患者作为高危群体,无法从喀麦隆的免费或补贴疟疾预防和治疗中受益,这可能是由于缺乏足够的证据来指导政策制定者。本研究旨在描述疟疾患者的临床和社会人口特征,确定住院儿童以及患有 SCD 和非 SCD 的儿童中疟疾的患病率,比较疟疾相关并发症的出现频率(使用定义严重疟疾的临床和实验室要素) )在因疟疾入院的患有 SCD 的儿童和没有 SCD 的儿童之间进行比较,最后确定因疟疾入院的儿童死亡的危险因素。方法 这是对 2015 年 1 月至 2018 年 12 月期间在 Laquintinie 医院收治的 1 至 18 岁确诊疟疾儿童的入院记录进行回顾性分析。研究了按 SCD 状态分层的疟疾感染的临床特征、实验室特征和结果。HIV感染、营养不良、肾功能衰竭和不按医嘱出院的患者被排除在研究之外。使用 Epi-info 7 软件分析数据并完成分析。卡方检验、优势比、CI 和学生 t 检验用于确定变量之间的关联。统计显着性设定为 p 值 ≤0.05。结果 SCD 儿童的疟疾患病率低于非 SCD 儿童(23.5% vs 44.9%)。同样,在镜检呈阳性的患者中,SCD 儿童的平均寄生虫密度显着低于未患 SCD 的儿童(22,875.6 和 57,053.6 寄生虫/μl,t 值 - 3.2,p 值 0.002)。与非 SCD 相比,SCD 的平均血红蛋白浓度较低(5.7 g/l vs 7.4 g/l,t 值 - 12.5,p 值 < 0.001)。SCD 患者的总体死亡率为 3.4%,其中 20.4% 是由疟疾造成的,而非 SCD 患者的这一比例为 35.4%。SCD 组的惊厥和意识障碍明显较低(分别为 OR:0.1,CI:0.1-0.3,p 值 < 0.01 和 OR:0.1,CI:0.1-0.2,p 值 < 0.001)。与因其他疾病入院的 SCD 患者相比,患有疟疾的 SCD 患者的死亡率显着更高(3.2% vs 1.5%,OR:2.2,CI:1-5,p 值 0.050)。结论 与非 SCD 人群相比,SCD 人群与疟疾相关的死亡率较低。与此同时,在 SCD 人群中,因疟疾入院的患者死亡可能性是因其他疾病入院的患者的两倍。黄疸、肝肿大和脾肿大在伴有疟疾的 SCD 中很常见,
更新日期:2020-01-15
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