Inpatient mortality in children with clinically diagnosed malaria as compared with microscopically confirmed malaria

Robert O. Opoka, Zongqi Xia, Paul Bangirana, Chandy John

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

BACKGROUND: Inpatient treatment for malaria without microscopic confirmation of the diagnosis occurs commonly in sub-Saharan Africa. Differences in mortality in children who are tested by microscopy for Plasmodium falciparum infection as compared with those not tested are not well characterized. METHODS: A retrospective chart review was conducted of all children up to 15 years of age admitted to Mulago Hospital, Kampala, Uganda from January 2002 to July 2005, with a diagnosis of malaria and analyzed according to microscopy testing for P. falciparum. RESULTS: A total of 23,342 children were treated for malaria during the study period, 991 (4.2%) of whom died. Severe malarial anemia in 7827 (33.5%) and cerebral malaria in 1912 (8.2%) were the 2 common causes of malaria-related admissions. Children who did not receive microscopy testing had a higher case fatality rate than those with a positive blood smear (7.5% versus 3.2%, P <0.001). After adjustment for age, malaria complications, and comorbid conditions, children who did not have microscopy performed or had a negative blood smear had a higher risk of death than those with a positive blood smear [odds ratio (OR): 3.49, 95% confidence interval (CI): 2.88-4.22, P <0.001; and OR: 1.59, 95% CI: 1.29-1.96, P <0.001, respectively]. CONCLUSIONS: Diagnosis of malaria in the absence of microscopic confirmation is associated with significantly increased mortality in hospitalized Ugandan children. Inpatient diagnosis of malaria should be supported by microscopic or rapid diagnostic test confirmation.

Original languageEnglish (US)
Pages (from-to)319-324
Number of pages6
JournalPediatric Infectious Disease Journal
Volume27
Issue number4
DOIs
StatePublished - Apr 2008
Externally publishedYes

Fingerprint

Child Mortality
Malaria
Inpatients
Microscopy
Plasmodium falciparum
Odds Ratio
Confidence Intervals
Cerebral Malaria
Hospitalized Child
Uganda
Mortality
Africa South of the Sahara
Routine Diagnostic Tests
Anemia

Keywords

  • Children
  • Malaria
  • Microscopy
  • Mortality
  • Plasmodium falciparum

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)

Cite this

Inpatient mortality in children with clinically diagnosed malaria as compared with microscopically confirmed malaria. / Opoka, Robert O.; Xia, Zongqi; Bangirana, Paul; John, Chandy.

In: Pediatric Infectious Disease Journal, Vol. 27, No. 4, 04.2008, p. 319-324.

Research output: Contribution to journalArticle

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N2 - BACKGROUND: Inpatient treatment for malaria without microscopic confirmation of the diagnosis occurs commonly in sub-Saharan Africa. Differences in mortality in children who are tested by microscopy for Plasmodium falciparum infection as compared with those not tested are not well characterized. METHODS: A retrospective chart review was conducted of all children up to 15 years of age admitted to Mulago Hospital, Kampala, Uganda from January 2002 to July 2005, with a diagnosis of malaria and analyzed according to microscopy testing for P. falciparum. RESULTS: A total of 23,342 children were treated for malaria during the study period, 991 (4.2%) of whom died. Severe malarial anemia in 7827 (33.5%) and cerebral malaria in 1912 (8.2%) were the 2 common causes of malaria-related admissions. Children who did not receive microscopy testing had a higher case fatality rate than those with a positive blood smear (7.5% versus 3.2%, P <0.001). After adjustment for age, malaria complications, and comorbid conditions, children who did not have microscopy performed or had a negative blood smear had a higher risk of death than those with a positive blood smear [odds ratio (OR): 3.49, 95% confidence interval (CI): 2.88-4.22, P <0.001; and OR: 1.59, 95% CI: 1.29-1.96, P <0.001, respectively]. CONCLUSIONS: Diagnosis of malaria in the absence of microscopic confirmation is associated with significantly increased mortality in hospitalized Ugandan children. Inpatient diagnosis of malaria should be supported by microscopic or rapid diagnostic test confirmation.

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