Malaria in rural Mozambique.: Part II:: Children admitted to hospital
Malaria in rural Mozambique.: Part II:: Children admitted to hospital
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DOI：
10.1186/1475-2875-7-37
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发表时间：
2008-02-26
期刊：
影响因子：
3
通讯作者：
Alonso, Pedro L.
中科院分区：
文献类型：
--
作者：
Bassat, Quique;Guinovart, Caterina;Alonso, Pedro L.
背景：严重疟疾病例到达医院时的特征可能有助于早期识别和改善管理。最低社区发病率（MCBIR）补充了医院数据，描述了社区的疟疾负担。方法：对2003年6月至2005年5月期间莫桑比克乡村医院收治的所有疟疾病例进行了回顾性分析。计算了每种体征和症状的患病率和病死率（CFR）。使用逻辑回归来识别作为死亡独立危险因素的变量。疟疾和严重疟疾的 MCBIR 使用人口监测系统的数据进行计算。结果：在研究期间入院的 8,311 名患者中，几乎一半患有疟疾，13.2% 患有严重疟疾。两岁以下儿童几乎占所有疟疾病例的 60%。疟疾的病死率为 1.6%，重症疟疾的病死率为 4.4%。几乎 19% 的儿科医院死亡病例是由疟疾引起的。虚脱（55.0%）、呼吸窘迫（41.1%）和严重贫血（17.3%）是严重疟疾病例中最常见的症状。严重贫血和无法寻找母亲乳房是八个月以下婴儿死亡的独立危险因素。对于八个月至四岁的儿童，危险因素是营养不良、低血糖、胸部凹陷、无法坐立和呕吐史。严重疟疾病例的 MCBIR 在六个月至两岁的儿童中最高。在整个研究期间，每 1,000 名面临严重疟疾风险的儿童年的严重疟疾 MCBIR 为：婴儿 27 例，1 至 < 5 岁儿童 23 例，5 岁以上儿童 2 例。结论：疟疾仍然是莫桑比克农村地区的第一大入院原因，主要影响幼儿，而幼儿的死亡风险也较高。为保护生命头两年儿童而设想的措施可能会比任何其他年龄段产生更大的影响。
Background: Characterization of severe malaria cases on arrival to hospital may lead to early recognition and improved management. Minimum community based-incidence rates ( MCBIRs) complement hospital data, describing the malaria burden in the community.Methods: A retrospective analysis of all admitted malaria cases to a Mozambican rural hospital between June 2003 and May 2005 was conducted. Prevalence and case fatality rates ( CFR) for each sign and symptom were calculated. Logistic regression was used to identify variables which were independent risk factors for death. MCBIRs for malaria and severe malaria were calculated using data from the Demographic Surveillance System.Results: Almost half of the 8,311 patients admitted during the study period had malaria and 13,2% had severe malaria. Children under two years accounted for almost 60% of all malaria cases. CFR for malaria was 1.6% and for severe malaria 4.4%. Almost 19% of all paediatric hospital deaths were due to malaria. Prostration ( 55.0%), respiratory distress ( 41.1%) and severe anaemia ( 17.3%) were the most prevalent signs among severe malaria cases. Severe anaemia and inability to look for mother's breast were independent risk factors for death in infants younger than eight months. For children aged eight months to four years, the risk factors were malnutrition, hypoglycaemia, chest indrawing, inability to sit and a history of vomiting. MCBIRs for severe malaria cases were highest in children aged six months to two years of age. MCBIRs for severe malaria per 1,000 child years at risk for the whole study period were 27 in infants, 23 in children aged 1 to < 5 years and two in children aged >= 5 years.Conclusion: Malaria remains the number one cause of admission in this area of rural Mozambique, predominantly affecting young children, which are also at higher risk of dying. Measures envisaged to protect children during their first two years of life are likely to have a greater impact than at any other age.