Prevalence and factors associated with malaria among children with sickle cell anaemia and fever attending Mulago Hospital.

Abstract

Background: Co-endemic existence of malaria and Sickle Cell Anaemia (SCA) has been associated with high mortality and morbidity in sub Saharan Africa. Despite existing control interventions, high risk populations like children with SCA have continued to suffer high rates of malaria and also have a poorer prognosis. Varied prevalences of malaria in sickle cell anaemia have been documented in several African studies. In Uganda, limited available data shows that the prevalence of malaria among children with SCA may be on the increase with a 9.6% increment seen between 2002 and 2007. Whereas there has been scale up of preventive interventions, their impact on the prevalence of malaria in different populations like children with SCA has not been well described.

Objective: To determine the prevalence and describe the factors associated with malaria among children with SCA and fever attending Mulago Hospital.

Methods: This was a cross sectional study conducted between 13 August and 21 December 2012. Two hundred and ninety nine children with sickle cell anaemia aged 6months to 12 years who presented with fever were enrolled. After obtaining informed consent or assent, data on the socio-demographics, history and physical examination was collected on a standardised questionnaire. Blood tests included smear for malaria parasites, a complete blood count and HIV serology test. The chi square and fisher’s exact test were used were appropriate. Logistic regression analysis was done to determine factors that were independently associated with malaria. P value < 0.05 was considered significant.

Results: Two hundred and ninety nine children were enrolled with median age of 4.2 years (IQR 2, 6). The male to female ratio was 1:1. The prevalence of malaria in the study population was 5% (CI 95% 2.5, 7.5). An increased pulse rate was a statistically significant factor associated with malaria in the enrolled children. (p=0.027). Observations of 299 participants showed 92.6% had bed nets however only 48.2% were ITNs; 55.5% reported treatment with antimalarial drugs 14 days prior to hospital visit; 89% were on chemoprophylaxis and 69.6% used herbal drugs for fever. Only 1 child had HIV and 5.4% had received pneumococcal vaccine.

Conclusions: Findings showed the prevalence of malaria among children with sickle cell anaemia presenting with fever was low at 5% and a very high use of antimalarials in the 14 days prior to enrolment. It is however uncertain if the increased pulse rate is in fact clinically significant or helpful.

Recommendations: There is need for concerted efforts to investigate for other causes of fever other than malaria in children with SCA. A targeted advocacy plan should be developed by policy makers to investigate and create awareness of the dangers of antimalarial self-medication as well as scale up pneumococcal vaccination and other malaria preventative measures in this vulnerable population of children with Sickle cell anaemia.