Gaps in the childhood malaria burden in Africa: Cerebral malaria, neurological sequelae, anemia, respiratory distress, hypoglycemia, and complications of pregnancy
Gaps in the childhood malaria burden in Africa: Cerebral malaria, neurological sequelae, anemia, respiratory distress, hypoglycemia, and complications of pregnancy
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DOI：
10.4269/ajtmh.2001.64.57
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发表时间：
2001-01-01
影响因子：
3.3
通讯作者：
Breman, JG
中科院分区：
文献类型：
--
作者：
Murphy, SC;Breman, JG
对非洲儿童疟疾负担的评估没有充分量化脑型疟疾（CM）、CM相关神经系统后遗症、疟疾性贫血、呼吸窘迫、低血糖和妊娠相关并发症的贡献。我们估计了这些疟疾表现对5岁以下非洲人口的影响。计算基于广泛的文献综述，使用国家医学图书馆搜索引擎，其他书目来源和人口统计数据。在撒哈拉以南非洲，CM每年影响575，000名5岁以下儿童，110，000人死亡（类似于19%的病死率[CFR]）。CM的儿童幸存者经历发育和行为障碍：每年有9，000 - 19，000名儿童（> 2%，CM幸存者）< 5 years of age in Africa experience neurological complications lasting >6个月。严重的疟疾性贫血给医院带来了沉重的负担，入院率和CFR不断上升，治疗因有限的血液供应而变得复杂，有时血液供应受到污染。严重的疟疾贫血每年发生142 - 566万例，每年杀死190，000 - 974，000（> 13%CFR）儿童（5岁）。呼吸窘迫、低血糖和重叠的临床表现导致非洲疟疾儿童中112 - 199万例病例和> 225，000例（> 18%CFR）额外死亡。妊娠期母体、胎盘或胎儿感染疟疾会通过低出生体重、母体贫血以及可能的流产和死产对胎儿和新生儿的发育和存活产生不利影响。每年发生167，000至967，000例与疟疾相关的出生不足病例;疟疾引起的出生不足每年导致62，000至363，000名新生儿死亡（> 38% CFR）。所有的负担缺口包括每年40万至170万人死亡，其中> 50%是由于严重的疟疾贫血。这些疟疾引起的医疗问题构成了重大的临床、公共卫生和研究挑战，因为它们可能导致比一般公认的死亡率高一倍以上的死亡率。
Evaluations of the African childhood malaria burden do not fully quantify the contributions of cerebral malaria (CM), CM-associated neurological sequelae, malarial anemia, respiratory distress, hypoglycemia, and pregnancy-related complications. We estimated the impact of these malaria manifestations on members of the African population < 5 years old. Calculations were based on an extensive literature review that used National Library of Medicine search engines, other bibliographic sources, and demographic data. In sub-Saharan Africa, CM annually affects 575,000 children < 5 years of age and 110,000 (similar to 19% case fatality rate [CFR]) die. Childhood survivors of CM experience developmental and behavioral impairments: each year, 9,000-19,000 children (> 2%, of survivors of CM) < 5 years of age in Africa experience neurological complications lasting > 6 months. Severe malarial anemia heavily burdens hospitals with rising admission and CFRs and with treatments that are complicated by limited and sometimes contaminated blood supplies. Severe malarial anemia occurs 1.42-5.66 million rimes annually and kills 190,000-974,000 (> 13% CFR) children ( 5 years of age annually. Respiratory distress, hypoglycemia, and overlapping clinical manifestations cause 1.12-1.99 million cases and > 225,000 (> 18% CFR) additional deaths among African children with malaria. Maternal, placental, or fetal malaria infection during pregnancy adversely affects development and survival of fetuses and newborns through low birth weight (LBW), maternal anemia, and possibly abortion and stillbirth. Between 167,000 and 967,000 cases of malaria-associated LBW occur yearly; malaria-induced LBW kills 62,000-363,000 (> 38% CFR) newborns each year. All the gaps in the burden comprise 0.4-1.7 million deaths annually, > 50% of which are due to severe malarial anemia. These malaria-induced medical problems constitute major clinical, public health, and research challenges in that they may contribute to more than double the mortality than is generally acknowledged.