Prevalence and factors associated with malaria parasitemia in infants below 6 months of age on the out-patient clinic of Mulago Hospital

Abstract

BACKGROUND: Malaria remains the most important parasitic cause of mortality and morbidity in infants in sub-saharan Africa. Previously it had been thought that malaria in infants below six months of age was infrequent in endemic areas due to protection from maternally acquired antibodies. But over the past decade, reports of malaria in young infants have increased from different parts of Africa. The exact reason for apparent rise is unknown and maybe contributed by increased resistance of P, falciparum to anti-malarial drugs resulting in increased maternal parasitemia, increased virulence resulting from altered antigenic determinants, increased reporting of cases and increased prevalence of HIV infection among pregnant women. No study has been done in a meso endemic setting in young infants in Uganda. OBJECTIVE: To determine the prevalence and factors associated with malaria parasitemia in infants below six months of age attending assessment centre, Mulago hospital. METHODS: Four hundred twenty one infants below 6 months of age whose caretakers consented were consecutively enrolled into the study between 10th September 2007 and 30th January 2008. Records of clinical history, socio demographic characteristics, physical exam and laboratory investigations were recorded on a precoded questionnaire. Malaria parasites were detected using the microscopy method. STUDY RESULTS: The prevalence of malaria parasitemia below six months was 9.5% (95% C1: 7.0-12.8%). On multivariate analysis malaria parasitemia was independently associated with history of fever in past 24 hours. OR 3.65 (95% C1:1.77-7.53, P=0.00), diarrhea OR 2.71 (95% C1:1.26-5.83, p=0.01) and presence of anaemia OR 3.65 (95% C1:1.18-5.13, P=0.02). The history of living in a hyperendemic area, exclusive breast feeding, refusal of feed and clinical presentation of dyspnoea, WAZ score-<- 2SD and temperature -> 37.50 C were significantly associated with malaria parasitemia. In bivariate analysis but not on multivariate analysis. Age of the infant and HIV status of the mother were associated with malaria parasitemia. CONCLUSION AND RECOMMENDATIOS: Malaria parasitemia prevalence is 9.5% among infants below six months of age in mulago hospital out-patient clinic. Malaria infection should be investigated for in infants below 6 months of age presenting with ill health especially history of fever in the past 24 hours of history of diarrhea or presence of anaemia. Further studies are recommended with case control design to further evaluate factors leading to malaria parasitemia in young infants.