Prevalence and spectrum of illness among hospitalized adults with malaria in Blantyre, Malawi

Clinical manifestations and outcomes of severe malaria in adult patients admitted to a tertiary hospital in the Gambia

BACKGROUND

Malaria is a major public health concern in The Gambia. There is limited data on the clinical manifestation and outcome of severe malaria in adult patients in The Gambia. The study therefore assessed the clinical manifestations and outcome of severe malaria in adult patients admitted at the Edward Francis Small Teaching Hospital.

METHODS

The study retrospectively reviewed the records of all malaria patients admitted from 18th October 2020 to 2nd February 2022. Demographic data, clinical features, investigations, treatment, and outcomes were recorded.

RESULTS

A total of 131 confirmed malaria patients were recruited into the study. The median age was 21 yrs, range (15-90) and most of them were within the youth age group (15-24yrs) 85 (64.9%). The majority of the patients were also male 88 (67.2%) with a male to female ratio of 2:1. The most common symptom at presentation was fever 119 (90.8%) and the most common sign was pallor 48 (36.6%). Seventy-six patients (58.1%) and 55 (41.9%) patients met the criteria for severe malaria and uncomplicated malaria diagnosis, respectively. The most common clinical feature amongst patients with severe malaria were impaired consciousness 34 (44.7%), severe anaemia 26 (34.2%) and acute kidney injury 20 (26.3%). Patients with severe malaria were younger with mean age of 22.9 vs. 29 yrs (p = 0.004), more likely to be referred from a lower-level health facility 62 (81.6%) vs. 34 (61.8%) (p = 0.012), to have a longer duration of admission (p = 0.024) and to die 13 (17.1%) vs. 0 (0%) (p = 0.001) as compared to patients with uncomplicated malaria. The total mortality was 13 (9.9%) and all the patients who died had severe malaria. Mortality was higher in patients with impaired consciousness 9 (26.5%) and there was a significant relationship between death and impaired consciousness 9 (69.3%) vs. 25 (21.4%) p = 0.001.

CONCLUSION

Severe malaria still affects young adults in an endemic area with significant mortality. This suggests the need for targeted malaria prevention, surveillance, case management and control strategies in this population group in The Gambia to help reduce morbidity and mortality of malaria.

Treatment Outcome of Severe Malaria and Associated Factors among Adults Admitted in Arba Minch General Hospital, Southern Nation Nationality and People's Region, Ethiopia

INTRODUCTION

Malaria is a protozoan disease transmitted by the bite of infected female Anopheles mosquitoes. Progression to severe and fatal disease is largely but not entirely confined to Plasmodium falciparum infections. Malaria is a major public health problem in Ethiopia despite relatively low malaria prevalence compared to most other malaria-endemic countries in Africa. In Ethiopia, a nationwide report during 2015 showed that the total number of deaths associated with malaria was 1561.

METHODS

A retrospective cross-sectional study was conducted in Arba Minch General Hospital on February 2019. Data were collected from a patient record who was admitted with severe malaria in the past four years from Sept. 2015 to Aug. 2018.

RESULTS

This study included a total of 387 patients with severe malaria. The mortality rate associated with severe malaria in the year between 2015 and 2018 at Arba Minch General Hospital was 5.7%. Comorbidity, impaired consciousness, and acidosis were significantly associated with mortality, at significant level of P < 0.05.

CONCLUSIONS

Comorbidity, impaired consciousness, and acidosis were found to be poor prognostic indicators for patients with severe malaria.

The Effect of Frequent Exposure to P. falciparum, HIV-Infection and Other Co-Morbidities on Development of Severe Malaria in Malawian Adults

Aim

Plasmodium falciparum malaria predominantly affects children residing in endemic areas. However, recently a significant number of Malawian adults, who otherwise should have attained some malaria-specific immunity, have been observed to succumb to either uncomplicated malaria (UM) or severe malaria (SM). In addition, it is still unknown whether HIV is a contributing factor to SM in Malawian non-pregnant adults. We conducted this study to determine clinical and demographic features that characterize Malawian adults presenting with UM or SM.

Methods

Study participants were recruited when they presented at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi with UM or SM and had their demographic details recorded after consenting to participate in the study. Malaria infection was confirmed by Malaria Rapid Diagnostic Test (MRDT) and malaria slide microscopy. A venous blood sample was collected before treatment for various analyses.

Results

Both HIV-infected and HIV-uninfected participants were at risk of presenting with either UM or SM although there were more (37%) SM cases among those who were HIV-infected compared to those who were HIV-uninfected (28%) but the difference was not significant but similar numbers of UM cases (61% for HIV-uninfected and 60% for HIV-infected). Previous visit to areas of high malaria transmission was not associated with presenting with either UM or SM. HIV/malaria co-infected participants were more likely to be found with a positive blood culture result (Diphtheriods, Stenotophomonas maltophilia, Salmonella typhimurium and Staphylococcus aureus) and were at a higher risk of dying compared to HIV-uninfected malaria patients.

Conclusion

Although HIV-infection was associated with high mortality in those co-infected with HIV and malaria, recurrent malaria episodes and having other diseases co-existing with malaria infection were the main factors associated with the development of SM in this study cohort. Further studies need to be done to determine how the host immunity is affected in those co-infected with HIV and malaria.

Outcomes of Biliointestinal Bypass among Iranian Obese Patients

Background  There are several surgical approaches to treat obesity not cured with medical approaches. Each method has its advantages and complications. In here, we have conducted a study to evaluate complications of biliointestinal bypass surgery (BIBP). Methods  A prospective study was conducted in a private hospital from 2002 to 2016. Those patients, not previously operated for morbid obesity, were eligible. Mean follow-up period was 89 months ( ± 54 months; range: 73-108 months). Main outcome measures were weight, BMI (body mass index), concentrations of blood lipids and glucose, liver transaminases, and obesity-related comorbidities and complications. Results  Twenty-three consecutive patients with morbid obesity, including 16 women (69.7%) and seven men (31.3%) with mean age 38.47 ± 10 years (range: 26-57 years) underwent surgery. At the end of follow-up period, a mean BMI reduction of 12.2 kg/m 2 kg/m 2 ( p  < 0.001)] was observed. An excess weight loss (EWL) of 63% ( ± 34) was achieved at the end of the study. Additionally, total cholesterol and triglyceride levels decreased postoperative significantly. The main long-term complications were flatulence (60%), borborygmus (47.8%), mal odorous stool (30.4%), and diarrhea (21.7%). Revision rate was 4.34%. There were no cases with irreversible hepatic injury, deaths due to the surgery, or progressive renal failure. Conclusion BIBP seems to be a safe, easily reversible, and one of valid therapeutic approaches in morbidly obese patients. BIBP has the potential to achieve durable weight loss and offers an improved quality of life.

Epidemiology of Severe Acute Respiratory Illness and Risk Factors for Influenza Infection and Clinical Severity among Adults in Malawi, 2011-2013

Data on the epidemiology of severe acute respiratory illness (SARI) in adults from low-income, high human immunodeficiency virus (HIV) prevalence African settings are scarce. We conducted adult SARI surveillance in Blantyre, Malawi. From January 2011 to December 2013, individuals aged ≥ 15 years with SARI (both inpatients and outpatients) were enrolled at a large teaching hospital in Blantyre, Malawi. Nasopharyngeal aspirates were tested for influenza and other respiratory viruses by polymerase chain reaction. We estimated hospital-attended influenza-positive SARI incidence rates and assessed factors associated with influenza positivity and clinical severity (Modified Early Warning Score > 4). We enrolled 1,126 SARI cases; 163 (14.5%) were positive for influenza. Human immunodeficiency virus prevalence was 50.3%. Annual incidence of hospital-attended influenza-associated SARI was 9.7–16.8 cases per 100,000 population. Human immunodeficiency virus was associated with a 5-fold greater incidence (incidence rate ratio 4.91, 95% confidence interval [CI]: 3.83–6.32). On multivariable analysis, female gender, as well as recruitment in hot, rainy season (December to March; adjusted odds ratios (aOR): 2.82, 95% CI: 1.57–5.06) and cool, dry season (April to August; aOR: 2.47, 95% CI: 1.35–4.15), was associated with influenza positivity, whereas influenza-positive patients were less likely to be HIV-infected (aOR: 0.59, 95% CI: 0.43–0.80) or have viral coinfection (aOR: 0.51, 95% CI: 0.36–0.73). Human immunodeficiency virus infection (aOR: 1.86; 95% CI: 1.35–2.56) and recruitment in hot, rainy season (aOR: 4.98, 95% CI: 3.17–7.81) were independently associated with clinical severity. In this high HIV prevalence population, influenza was associated with nearly 15% of hospital-attended SARI. Human immunodeficiency virus infection is an important risk factor for clinical severity in all-cause and influenza-associated SARI. Expanded access to HIV testing and antiretroviral treatment, as well as targeted influenza vaccination, may reduce the burden of SARI in Malawi and other high HIV prevalence settings.

Urban Malaria: Understanding its Epidemiology, Ecology, and Transmission Across Seven Diverse ICEMR Network Sites

A major public health question is whether urbanization will transform malaria from a rural to an urban disease. However, differences about definitions of urban settings, urban malaria, and whether malaria control should differ between rural and urban areas complicate both the analysis of available data and the development of intervention strategies. This report examines the approach of the International Centers of Excellence for Malaria Research (ICEMR) to urban malaria in Brazil, Colombia, India (Chennai and Goa), Malawi, Senegal, and Uganda. Its major theme is the need to determine whether cases diagnosed in urban areas were imported from surrounding rural areas or resulted from transmission within the urban area. If infections are being acquired within urban areas, malaria control measures must be targeted within those urban areas to be effective. Conversely, if malaria cases are being imported from rural areas, control measures must be directed at vectors, breeding sites, and infected humans in those rural areas. Similar interventions must be directed differently if infections were acquired within urban areas. The hypothesis underlying the ICEMR approach to urban malaria is that optimal control of urban malaria depends on accurate epidemiologic and entomologic information about transmission.