Prevalence and factors associated with malaria in children receiving systemic cancer chemotherapy at Uganda Cancer Institute
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Background: Although significant strides have been made towards prevention, malaria remains endemic in parts of Uganda and is still one of the top 5 causes of mortality among children aged under 5 years. The detection of paediatric cancers is increasing in Uganda. Systemic chemotherapy, which is the mainstay of treatment of paediatric cancers, is associated with immunosuppression, and, therefore, an increase in risk of infections. There are no known published data on the prevalence of malaria in children receiving systemic cancer chemotherapy in Uganda. Objective: To determine the prevalence, associated factors, and outcomes of malaria in children receiving systemic cancer chemotherapy in a setting endemic for malaria. Methods: An analytical cross-sectional study with a longitudinal component of children aged ≤ 15 years that were receiving systemic cancer chemotherapy at Uganda Cancer Institute was conducted. Malaria was tested by thick smear microscopy. Data on factors associated with, clinical features and outcomes of malaria was collected using a structured questionnaire. Children found to have malaria were followed up for 28 days to determine their clinical outcomes. Data were analyzed using STATA 14.0. Continuous variables were summarized using means and standard deviations or medians and interquartile ranges while frequencies and percentages were used for categorical variables. Logistic regression was used to determine factors associated with malaria and outcomes were summarized as medians and interquartile ranges. Results: Of the 249 children aged 15 years and younger, 16/249 [6.4% (CI: 3.96-10.26)] had malaria. Of the children that had positive smears, only one had asymptomatic parasitemia. Three out of sixteen children (18.8%) had severe malaria. The median age of the children was 8 (IQR: xiii | P a g e 4-12) years and majority (55%) were males. A one month increase in duration of chemotherapy was associated with an 8% increased odds of having malaria [AOR: 1.08 (95% CI: 1.01-1.15)]. Children with severe neutropenia [AOR: 4.74 (95% CI: 1.16-19.41)] were about 5 times more likely to have malaria while mosquito net use was 83% protective against malaria [AOR: 0.17 (95% CI: 0.04-0.63)]. The clinical features of malaria were fever, vomiting, general malaise, headache and joint pain. 3 out of 16 children had severe malaria. The median time to fever resolution was 2 days (IQR: 2-3) and to parasite clearance was 3 days (IQR: 2-4). After 28 days of follow up, all children were alive. Conclusion and recommendations: The period prevalence of malaria was found to be low in this population with 1 in every 15 children being affected. The children with malaria mainly presented with fever. The factors associated with malaria were; mosquito net use which was protective as well as severe neutropenia and duration of chemotherapy both of which increased the odds of having malaria. All children were alive at the end of follow up and their fever and parasitemia had resolved. Further studies are recommended among cancer patients on chemotherapy who develop neutropenia to generate stronger evidence about the burden of malaria in this population.