The prevalence and clinical presentation of inpatient malaria in children between five and fifteen years old in a malaria endemic area after the scale up of malaria control interventions

Abstract

Introduction: Malaria is a disease that affects all age groups but more especially children under five years’ old, pregnant women, and school going children of all ages. Increasing success in lowering the level of malaria transmission in many previously highly endemic areas will result in children acquiring immunity to malaria later in life than has been the case in the past. Thus, it can be anticipated that in the coming years there will be an increase in the incidence of both uncomplicated and severe malaria in school-age children in many previously highly endemic areas. Objective: The objective of the study was to find out the prevalence and presentation pattern of inpatient malaria in children between 5 and 15 years of age and uptake of malaria control interventions in this age group. Methods: The study was conducted at the pediatric hospital of Jinja regional referral hospital between January and March 2019. We conducted a conduct a cross-sectional study with 216 participants on the prevalence of severe malaria and the clinical presentation of malaria in the inpatient setting of the pediatric hospital at Jinja regional referral hospital in children between 5 and 15 years of age. We also looked at the uptake of malaria control strategies by the children taking part in the study. The study targeted children between 5 and 15 years of age admitted with fever or a history of fever at the pediatric hospital at Jinja regional referral hospital. Results: The prevalence of inpatient malaria was found to be 64% [n=138 (95% CI 57-70)]. Severe malaria among this group was found to be at 42% [n=138 (95% CI 35-48)]. Of the children who had a positive malaria test 65% [n=90 (95% CI 60-73)] had severe malaria while 35% [n=48 (%% CI 27-43)] had uncomplicated malaria and 94% [n=202 (95% CI 89-97)] were using a malaria control measure. Use of LLITNs was the most common strategy used at 94% [n=194] followed by use of ACT to treat attacks at 75% [n=155]. Environmental vector control measures were used by 56% [n=114]. Male children (OR0.08, 95% CI 0.02-0.29, P-Value 0.000) were more at risk of having malaria as were those living in an urban setting (OR 0.06, 95%CI 0.02-0.29, P-Value 0.000) and those with a household monthly income is less than 200000 Uganda shillings (OR 4.71, 95% CI 1.4- 15.74, P-Value 0.012). Conclusion: High-transmission countries such as Uganda already bear a disproportionate burden of this terrible disease and will likely require further scaling up of widely accepted existing interventions and possibly novel approaches including vaccination to realize the successes now being celebrated in other parts of the world.