Human immunodeficiency virus infection and cerebral malaria in children in Uganda: a case-control study

<p>Abstract</p> <p>Background</p> <p>Human immunodeficiency virus (HIV)-1 infection increases the burden of malaria by increasing susceptibility to infection and decreasing the response to malarial treatment. HIV-1 has also been found to suppress the immune system and predispose to severe forms of malaria in adults. There is still a paucity of data on the association between HIV-1 infection and cerebral malaria in children. The aim of this study was to determine whether HIV-1 infection is a risk factor for cerebral malaria in children.</p> <p>Method</p> <p>We conducted an unmatched case-control study, in which 100 children with cerebral malaria were compared with 132 with uncomplicated malaria and 120 with no malaria. In stratified analyses we estimated odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for age.</p> <p>Results</p> <p>HIV-1 infection was present in 9% of children with cerebral malaria compared to 2.3% in uncomplicated malaria (age-adjusted odds ratio (aOR) 5.94 (95% confidence interval (CI) 1.36-25.94, p = 0.012); and 2.5% in children with no malaria (aOR 3.85 (95% CI0.99-14.93, p = 0.037). The age-adjusted odds of being HIV-positive among children with cerebral malaria compared to the control groups (children with uncomplicated malaria and no malaria) was 4.98 (95% CI 1.54-16.07), p-value = 0.003.</p> <p>Conclusions</p> <p>HIV-1 infection is associated with clinical presentation of cerebral malaria in children. Clinicians should ensure that children diagnosed with HIV infection are initiated on cotrimoxazole prophylaxis as soon as the diagnosis is made and caretakers counselled on the importance of adherence to the cotrimoxazole towards reducing the risk of acquiring <it>P.falciparum </it>malaria and associated complications such as cerebral malaria. Other malaria preventive measures such as use of insecticide-treated mosquito nets should also be emphasized during counselling sessions.</p

Invasive bacterial co-infection in African children with Plasmodium falciparum malaria: a systematic review.

Background: Severe malaria remains a major cause of pediatric hospital admission across Africa. Invasive bacterial infection (IBI) is a recognized complication of Plasmodium falciparum malaria, resulting in a substantially worse outcome. Whether a biological relationship exists between malaria infection and IBI susceptibility remains unclear. We, therefore, examined the extent, nature and evidence of this association.Methods: We conducted a systematic search in August 2012 of three major scientific databases, PubMed, Embase and Africa Wide Information, for articles describing bacterial infection among children with P. falciparum malaria using the search string (malaria OR plasmodium) AND (bacteria OR bacterial OR bacteremia OR bacteraemia OR sepsis OR septicaemia OR septicemia). Eligiblity criteria also included studies of children hospitalized with malaria or outpatient attendances in sub-Saharan Africa.Results: A total of 25 studies across 11 African countries fulfilled our criteria. They comprised twenty cohort analyses, two randomized controlled trials and three prospective epidemiological studies. In the meta-analysis of 7,208 children with severe malaria the mean prevalence of IBI was 6.4% (95% confidence interval (CI) 5.81 to 6.98%). In a further meta-analysis of 20,889 children hospitalised with all-severity malaria and 27,641 children with non-malarial febrile illness the mean prevalence of IBI was 5.58 (95% CI 5.5 to 5.66%) in children with malaria and 7.77% (95% CI 7.72 to 7.83%) in non-malaria illness. Ten studies reported mortality stratified by IBI. Case fatality was higher at 81 of 336, 24.1% (95% CI 18.9 to 29.4) in children with malaria/IBI co-infection compared to 585 of 5,760, 10.2% (95% CI 9.3 to 10.98) with malaria alone. Enteric gram-negative organisms were over-represented in malaria cases, non-typhoidal Salmonellae being the most commonest isolate. There was weak evidence indicating IBI was more common in the severe anemia manifestation of severe malaria.Conclusions: The accumulated evidence suggests that children with recent or acute malaria are at risk of bacterial infection, which results in an increased risk of mortality. Characterising the exact nature of this association is challenging due to the paucity of appropriate severity-matched controls and the heterogeneous data. Further research to define those at greatest risk is necessary to target antimicrobial treatment. © 2014 Church and Maitland; licensee BioMed Central Ltd

The Prevalence And Intensity Of Malaria Parasite In Children At Jos University Teaching Hospital, Nigeria

Objective: To determine the prevalence and intensity of malaria parasitaemia in clinically diagnosed paediatric patients in jos university teaching hospital, and to see if there is any correlation between the parasite density and the ages of the patients Study population/methods: Consisted of blood samples from 300 children aged between 0-14 years attending the Emergency Paediatric Unit and Paedratic Out-patient Department of theu Jos University Teaching Hospital Jos, with sign /symptoms suggestive of malaria. Blood collect aseptically in sterile containers. Thick and thin film were made using Giemsa staining technique. The stain examined under X100 objective microscope. Result: Revealed a parasite rate of 29.3% with p. falciparum 96.6%, p. maleria 3.4%. Eihteen percent of the study population had mean parasite desities higher than the critical value of 10,000 per microlitre. There was no difference in parasitaemia in relation to gender. Conclusion: The prevalence of maleria is still high in paediatric age group 27 – 29.5%. There is the need to intensify the Roll Back Malaria programme by the Federal Government of Nigeria in order to reduce the prevalence of malaria. Key words: Prevalence, Malaria, Children. Highland Medical Research Journal Vol.1(1) 2002: 9-1

Clinical and Epidemiological Features of Childhood Acute Lower Respiratory Infections (ALRI) in Jos.

Summary: The clinical and epidemiological features of acute lower respiratory infections (ALRI) in 114 children admitted into the Emergency Paediatric Unit (EPU) of the jos University Teaching Hospital over a twelve-month period, was studied prospectively. They were aged one month to 12 years with 69 (60.5 percent) aged two years and below. Ninety four (82.5 percent) of the children had bronchopneumonia, 16 (14 percent) had lobar pneumonia, while four (3.5 percent) had acute bronchiolitis. Common features observed among the study population included low socio-economic status, malnutrition, associated measles, low maternal education, overcrowding in sleeping rooms and domestic fuel air pollution. Sixteen (14 percent) of the children died. A majority (93.8 percent) of those who died were aged two years and below and 56.3 percent died within 24 hours of presentation. Mortality was higher among children less than two years of age, those with severe malnutrition, associated measles and who presented late to hospital. It is suggested that efforts be made towards health education of parents to recognise features of ALRI and seek éarly medical attention. The need for improved socio-economic conditions, efficient case management of acute respiratory infection by primary health care workers and sustained iminunization against childhood communicable diseases, particularly measles, is advocated

Clinical pattern and outcome in children with acute severe falciparum malaria at Jos University Teaching Hospital, Nigeria

A prospective study was undertaken to determine the clinical pattern and outcome among children admitted with acute severe malaria into the emergency paediatric unit (EPU) at the Jos University Teaching Hospital (JUTH) over a 15-month period (between August 1991 -October 1992). Five hundred and one (25%) children were admitted with acute severe malaria, out of a total of 2008 admissions into the EPU during the study period. Blood smears for malaria parasites were positive in 287 (57.7%) of the children and P. falciparum was the only species identified in the study. Seventy one percent of the children admitted were aged 5 years and below. Febrile convulsions was the commonest manifestation of acute severe malaria, accounting for 49.7% of the cases. Majority (97.8%) of the children responded satisfactorily to chloroquine therapy with clearance of parasitaemia. Associated bacteraemia was documented in 35 (7%) of the 501 children. Sixteen out of the 501 children died, giving a mortality of 3.2%. Cerebral malaria, which accounted for only 17.6% of the admissions, was responsible for 56.3% of all the deaths. Mortality was also associated with hypoglycaemia, severe anaemia, shock and repeated, prolonged seizures

Prevalence of hepatitis B surface antigen in vaccinated children and controls in rural Nigeria

SummaryObjective:To determine the prevalence of hepatitis B surface antigen (HBsAg) amongst vaccinated children and controls aged 1–4 years in a rural community in mid-western Nigeria.Methods:The vaccinated children had received at least three doses of hepatitis B vaccine. The vaccines included recombinant hepatitis B vaccine at birth and a combined diphtheria, tetanus, pertussis (whole cell) plus hepatitis B (DTPw-HBV) vaccine. HBsAg was determined by a rapid immunoassay method based on the immunochromatographic sandwich principle. Two hundred and twenty-three children and 219 controls were recruited into the study.Results:The prevalence of HBsAg was significantly lower in the vaccinated group (1.3%) than in the control group (4.6%, p=0.04). The prevalence rates were significantly higher in males (p=0.02) and two-year birth cohort (p=0.01). The controls were estimated to be at a six-fold higher risk of being positive for the surface antigen than the vaccinated children. The vaccine effectiveness was estimated to be approximately 80%.Conclusion:These results confirm that hepatitis B vaccine protects against hepatitis B surface antigen carriage and confirm immunogenicity of the combined DTPw-HBV vaccine