A study to determine the morbidity and mortality patterns of malaria in children in a very low transmission setting

Background: Despite several strides made to control malaria in Zambia, it still is
endemic in many parts of the country and remains one of the leading causes of
morbidity and mortality. Its epidemiology is characterised by varying transmission
intensities which may bring about change in the patterns of malaria morbidity and
mortality.
Objective: To determine the patterns of malaria morbidity and mortality among children
presenting to the University Teaching Hospital (UTH), Lusaka, Zambia, a very low
malaria transmission zone.
Method: The study was conducted between November 2014 and August 2015.
Residents of Lusaka aged 0 - 15 years with MPS or RDT confirmed malaria were
enrolled. Their data on demographic characteristics, clinical presentation, laboratory
and treatment outcomes were collected using a questionnaire and entered into EpiData
and transferred into STATA statistical package version 12 for analysis.
Results: Total enrolled were 109 aged between 2 months to 15 years (median 5.6 years;
inter quartile range [IQR] 3 – 8 years). The commonest symptom was fever at 94%.
Proportions of uncomplicated and complicated malaria cases were 50.5% and 49.5%,
respectively. History of travel was 54.6% among those with complicated and 45.4%
with uncomplicated malaria. Infancy was not significantly associated with an increased
risk of complicated malaria compared to ages 1-5years (OR 0.18, 95 CI: 0.02 – 1.67,
p=0.13) and over 5 years (OR 0.18, 95 CI: 0.02 - 1.64, p=0.13). Children without
history of travel were less likely to suffer from severe malarial anaemia compared to
those who had (OR 1.65, 95 CI: 0.69 – 3.95, p=0.26). Infancy compared to ages 1-5
years (OR 0.64, 95 CI: 0.08 – 4.89, p=0.67) and above 5 years (OR 0.92, 95 CI: 0.13 –
6.38, p=0.93) and history of travel (OR 0.38, 95 CI: 0.12 – 1.25, p=0.17) were not
significantly associated with increased risk of cerebral malaria. Four (3.7%) died, all
without history of travel and all from cerebral malaria (CFR 21.1%).
Conclusion: Severe malarial anaemia was the commonest pattern of severe disease.
Mortality was unexpectedly low in this cohort of children. There is need for similar
studies to be done periodically to monitor changes overtime.