Haematological indices, nutritional assessment and mortality outcome of children presenting with severe malaria to a tertiary hospital in Ghana

Year 2013, Volume: 5 , - , 09.07.2013

Daniel Ansong , Alex Osei-akoto Sandra Owusu Isaac Boakye Samuel Blay Nguah David Sambian Justice Sylverken Bernard Arhin

Abstract

Background: Severe malaria in children remains the commonest clinical disease in the paediatric emergency units of most hospitals in sub-Saharan Africa. Anaemia and nutritional deficiency are associated with severe malaria. The aim of the study was to describe the haematological indices, nutritional status and mortality among children admitted in a tertiary hospital in Ghana with severe malaria.

Methods: We conducted a prospective cross-sectional study documenting the haematological, nutritional indices and mortality outcomes of children less than five years reporting to the Komfo Anokye Teaching Hospital with severe malaria.

Results: The study recruited four-hundred-and-eight (408) children between April, 2005 and July, 2006. There were 231 males (57%). The median age was 21 months, (1QR: 4-54months). 36 (8.8%) patients had weight-for-age z-score <-3; 101 (24.7%) had z-score ≥-3 to < -2; 130 (31.9%) had z-scores ≥-2 to <-1 and 141 (34.6%) had z-scores ≥-1. The mean haemoglobin level was 6.2g/dl (SD=2.2, 95% CI: 6.0-6.4). The mean haemoglobin levels of children with normal, mild, moderate, and severe malnutrition were 6.5g/dl, 6.0g/dL, 6.0g/dL, and 6.0g/dL, respectively, p=0.15. The overall case fatality rate was 4.9%. Children with malnutrition (weight-for-age z-score ≤-2) had a significantly higher case fatality rate of 8.0% (11/126) compared to those with z-score > -2, 3.3% (RR=1.7, 95%CI: 1.1-2.6, P=0.038).

Conclusion: Malaria in children under five remains a principal cause of morbidity and mortality. The study did not find any association between the haemoglobin levels and the nutritional status. However, Mortality was associated with malnutrition (weight-for-age z-score ≤-2) in this study.

Keywords

Malnutrition; Severe malaria; Haematological indices; Children; Tertiary Hospital

References

• WHO. World Malaria Report 200 (UNICEF). Ahmad OB, Lopez AD, Inoue M. The decline in child mortality: a reappraisal. Bull World Health Organ. 2000;78:1175–91.
• Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet. 2003;28;361:2226–34.
• Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. How many child deaths can we prevent this year? Lancet. 2003; 5;362:65–
• Ehrhardt S, Burchard GD, Mantel C, Cramer JP, Kaiser S, Kubo M, et al. Malaria, anaemia, and malnutrition in African children--defining intervention priorities. J. Infect. Dis. 2006;1;194:108–14.
• Ghana Statistical Services (GSS). Ghana Demographic and Health Survey 2003. Calverton, Maryland: GSS, NMIMR and ORC Maco: Noguchi Memorial Institute for Medical Research (NMIMR), and ORC Marco; 2004 page 16–27.
• Adote W, Sackey M. Situational Analysis of Children and Women in Ghana. 2002 Revised Version;(UNICEP Report 2000).
• Ghana Statistical Services (GSS). Ghana Demographic and Health Survey 2008. Calverton, Maryland: GSS, NMIMR and ORC Maco: Noguchi Memorial Institute for Medical Research (NMIMR), and ORC Marco; 2009 Apr page 16–27.
• Komfo Anokye Teaching Hospital. Annual Statistics KATH 2004. Biostatistics Unit; 200
• Severe falciparum malaria. World Health Organization, Communicable Diseases Cluster. Trans. R. Soc. Trop. Med. Hyg. 2000;94 Suppl 1:S1–90.
• WHO | Pocket book of hospital care for children [Internet]. [cited 2011 Mar 2]. Available from: http://www.who.int/child _adolescent_health/documents/9241546700/e n/index.html
• Kurtzhals JAL, Helleberg M, Goka BQ, Akanmori BD. Severe malaria in west African children. Lancet. 2003; 19;361:1393.
• English M, Ahmed M, Ngando C, Berkley J, Ross A. Blood transfusion for severe anaemia in children in a Kenyan hospital. The Lancet. 2002;359:494–5.
• Alonso CMAFFP. Malaria-related anaemia. Parasitology Today. 2000;16(11).
• Koram KA, Owusu-Agyei S, Utz G, Binka FN, Baird JK, Hoffman SL, et al. Severe anaemia in young children after high and low malaria transmission seasons in the KassenaNankana district of northern Ghana. The American journal of tropical medicine and hygiene. 2000;62(6):670.
• Oduro AR, Koram KA, Rogers W, Atuguba F, Ansah P, Anyorigiya T, et al. Severe falciparum malaria in young children of the Kassena-Nankana district of northern Ghana. Malar J. 2007;6:96–102.
• Mulenga M, Malunga P, Bennett S, Thuma PE, Shulman C, Fielding K, et al. Factors associated with severe anaemia in Zambian children admitted with Plasmodium falciparum malarial anaemia. Ann Trop Paediatr. 2005;25:87–90.
• The health and nutritional status of schoolchildren in Africa: evidence from school-based health programmes in Ghana and Tanzania. The Partnership for Child Development. Trans. R. Soc. Trop. Med. Hyg. 1998;92:254–61.
• Kabatereine NB, Brooker S, Koukounari A, Kazibwe F, Tukahebwa EM, Fleming FM, et al. Impact of a national helminth control programme on infection and morbidity in Ugandan schoolchildren. Bull. World Health Organ. 2007;85:91–9.
• Menendez C, Fleming AF, Alonso PL. Malaria-related anaemia. Parasitol. Today (Regul. Ed.). 2000;16:469–76.
• Ronald LA, Kenny SL, Klinkenberg E, Akoto AO, Boakye I, Barnish G, et al. Malaria and anaemia among children in two communities of Kumasi, Ghana: a crosssectional survey. Malar J. 2006;5:105.
• Klinkenberg E, McCall PJ, Hastings IM, Wilson MD, Amerasinghe FP, Donnelly MJ. Malaria and irrigated crops, Accra, Ghana. Emerg Infect Dis. 2005;11:1290–3.
• Kurtzhals JA., Addae MM, Akanmori BD, Dunyo S, Koram KA, Appawu MA, et al. Anaemia caused by asymptomatic Plasmodium falciparum infection in semiimmune African school children. Transactions of the Royal Society of Tropical Medicine and Hygiene. 1999;93:623–7.
• Koram KA, Owusu-Agyei S, Fryauff DJ, Anto F, Atuguba F, Hodgson A, et al. Seasonal profiles of malaria infection, anaemia, and bednet use among age groups and communities in northern Ghana. Trop. Med. Int. Health. 2003;8:793–802.
• Klinkenberg E, McCall PJ, Wilson MD, Akoto AO, Amerasinghe FP, Bates I, et al. Urban malaria and anaemia in children: a cross-sectional survey in two cities of Ghana. Trop Med Int Health. 2006;11:578–88.
• Van de Poel E, Hosseinpoor A, Jehu-Appiah C, Vega J, Speybroeck N. Malnutrition and the disproportional burden on the poor: the case of Ghana. International Journal for Equity in Health. 2007;6:21.
• Alderman H, Unit WBSD of A. Nutritional status in Ghana and its determinants. World Bank; 1990.
• De Onis M, Monteiro C, Akré J, Clugston G. The worldwide magnitude of protein-energy malnutrition: an overview from the WHO Global Database on Child Growth. Bulletinworld health organization. 1993;71:703–703.
• De Onis M, Blossner M. The World Health Organization global database on child growth and malnutrition: methodology and applications. International Journal of Epidemiology. 2003;32:518.
• Renaudin P. Evaluation of the nutritional status of children less than 5 years of age in Moundou, Chad: correlations with morbidity and hospital mortality. Médecine tropicale: revue du Corps de santé colonial. 1997;57:49.
• Cartmell E, Natalal H, François I, Ferreira MH, Grahnquist L. Nutritional and clinical status of children admitted to the malnutrition ward, Maputo central hospital: a comparison of data from 2001 and 1983. J. Trop. Pediatr. 2005;51:102–5.
• Schellenberg D, Menendez C, Kahigwa E, Font F, Galindo C, Acosta C, et al. African children with malaria in an area of intense Plasmodium falciparum transmission: features on admission to the hospital and risk factors for death. Am J Trop Med Hyg. 1999 ;61:431–8.