| dc.description.abstract | 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:
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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. | en_US |
