TY - JOUR
T1 - Risk factors for mortality in children hospitalized with severe malaria in northern Zambia
T2 - A retrospective case-Control study
AU - Southern and Central Africa International Centers of Excellence for Malaria Research
AU - Ippolito, Matthew M.
AU - Kamavu, Luc K.
AU - Kabuya, Jean Bertin
AU - Tente, Catherine
AU - Chileshe, Edward
AU - Wapachole, McBerth
AU - Thuma, Philip E.
AU - Muleba, Mbanga
AU - Chaponda, Mike
AU - Mulenga, Modest
AU - Moss, William J.
N1 - Funding Information:
Financial support: This work was supported by the Johns Hopkins Malaria Research Institute, the Bloomberg Family Foundation, and the Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases as part of the International Centers of Excellence for Malaria Research (U19AI089680). M. M. I. was additionally supported by the National Institute of General Medical Sciences (T32GM066691), the Johns Hopkins Center for Global Health Paul S. Lietman Global Health Travel Fellowship, and the Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Division of Infectious Diseases of the Johns Hopkins University School of Medicine.
Funding Information:
This work was supported by the Johns Hopkins Malaria Research Institute, the Bloomberg Family Foundation, and the Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases as part of the International Centers of Excellence for Malaria Research (U19AI089680). M. M. I. was additionally supported by the National Institute of General Medical Sciences (T32GM066691), the Johns Hopkins Center for Global Health Paul S. Lietman Global Health Travel Fellowship, and the Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Division of Infectious Diseases of the Johns Hopkins University School of Medicine.
Publisher Copyright:
Copyright © 2018 by The American Society of Tropical Medicine and Hygiene.
PY - 2018
Y1 - 2018
N2 - Malaria remains a public health crisis in areas where it has resisted control efforts. In Nchelenge District, a high-transmission area in northern Zambia, malaria accounts for more than one-third of pediatric hospitalizations and nearly one-half of hospital deaths in children. To identify risk factors for death due to malaria, we conducted a retrospective, time-matched case-control study of 126 children hospitalized with malaria who died (cases) and 126 children who survived (controls). There were no differences in age, gender, hemoglobin concentration, or prevalence of severe anemia between cases and controls. Children who died were more likely to come from villages located at greater distances from the hospital than children who survived (median 13.5 versus 3.2 km). Each additional kilometer of distance from the hospital increased the odds of death by 4% (odds ratio 1.04, 95% confidence interval 1.01–1.07, P < 0.01). Extent of anemia and admission during periods when blood was unavailable for transfusion were associated with early death (P £ 0.03). Delays in initiation of treatment of severe malaria contribute to the increased odds of death in children referred from more distant health centers, and might be mitigated by transportation improvements, capacity at rural health posts to administer treatment before transfer, hospital triage systems that minimize time to treatment, and reliable blood product stores at referral hospitals.
AB - Malaria remains a public health crisis in areas where it has resisted control efforts. In Nchelenge District, a high-transmission area in northern Zambia, malaria accounts for more than one-third of pediatric hospitalizations and nearly one-half of hospital deaths in children. To identify risk factors for death due to malaria, we conducted a retrospective, time-matched case-control study of 126 children hospitalized with malaria who died (cases) and 126 children who survived (controls). There were no differences in age, gender, hemoglobin concentration, or prevalence of severe anemia between cases and controls. Children who died were more likely to come from villages located at greater distances from the hospital than children who survived (median 13.5 versus 3.2 km). Each additional kilometer of distance from the hospital increased the odds of death by 4% (odds ratio 1.04, 95% confidence interval 1.01–1.07, P < 0.01). Extent of anemia and admission during periods when blood was unavailable for transfusion were associated with early death (P £ 0.03). Delays in initiation of treatment of severe malaria contribute to the increased odds of death in children referred from more distant health centers, and might be mitigated by transportation improvements, capacity at rural health posts to administer treatment before transfer, hospital triage systems that minimize time to treatment, and reliable blood product stores at referral hospitals.
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U2 - 10.4269/ajtmh.17-1017
DO - 10.4269/ajtmh.17-1017
M3 - Article
C2 - 29692306
AN - SCOPUS:85048249774
SN - 0002-9637
VL - 98
SP - 1699
EP - 1704
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
IS - 6
ER -