Determining the burden and clinical spectrum of severe malaria from routine health facility based surveillance at Apac district hospital :

Abstract

Background: Most data describing severe malaria (SM) are from research settings, but these are driven by research funding. Routine facility-based data have therefore, not been given priority to contribute to the descriptions of the burden and clinical spectrum of Severe Malaria. Exploring routine facility-based data is critical for contribution of data from non-research settings and for a complete picture of disease. Despite very high (>1,500) entomological inoculation rates (EIR) in Apac, there are no formal descriptions of severe malaria from the region. The aim of this study was to establish the burden and clinical spectrum of severe malaria from routinely collected facility-based surveillance data among children admitted at Apac District Hospital. Materials and Methods: This was a cross sectional study taking the form of a secondary data review of the medical records of admissions in Apac District Hospital for the 24 months’ period of Jan 2019 to Dec 2020. I applied quantitative methodology of data collection and analysis. To determine the proportions of admissions resulting from severe malaria, all the 5631 records from the inpatient admission book was reviewed. Data abstraction of key variables was done on 745 files of admitted children who met the eligibility criteria using a customized proforma. The clean data were captured on excel database, exported to STATA version 14.0 statistical Package for further management and analysis. Univariate analyses included description of summary statistics including median age, proportions and frequencies, while Fisher's exact test was used to determine the associations with risk of death and clinical presentations of severe malaria. Multivariate analyses were done using multiple logistic regression to determine factors associated with prolonged Hospital stay. Results: The data routinely collected in Apac District Hospital had varying levels of completeness as follows; Age 100% (n=5631), sex 99.3% (n=5589), date of admission 99.1% (n=5583), date of discharge 40.6% (n=2281) and outcome status 56.5% (n=3180). Severe malaria was the common reason for admission in Apac District Hospital, contributing to 64.8% (n=3649) of the 5631 total admissions, ollowed by Pneumonia at 12.1% (n=681). The most common clinical presentations among these children with severe malaria in Apac District Hospital included; Fever 722 (97.3%), Cough 478 (64.2%), Vomiting 265 (38.7%), Diarrhea 192 (28.1%) and difficulty in breathing 122 (17.9%). The median length of hospital stay was 2(IQR; 2-4) days and 133 (17.9%) of the study participants stayed in the Hospital for more than 4 days (Prolonged stay). Majority of admitted children, 735 (98.7%) were Survivors while 10 (1.3%) died of malaria. At multivariate level, factors that were significantly associated with prolonged Hospital stay were, presenting with difficulty in breathing, aOR 1.83 (95%CI: 1.02-3.27, P=0.042) and Prostration aOR 8.47 (95%CI: 1.94-36.99, P=0.004). Conclusion: Malaria is the major cause of Hospital admission in Apac District Hospital. There is low death rate resulting from malaria admissions in Apac District Hospital. Prolonged Hospital stay was associated with prostration and difficulty in breathing. Recommendations: Patients presenting with difficulty in breathing and prostration need to be started on early treatment so as to reduce the length of Hospital stay. Apac District Hospital needs to improve on the quality of malaria data collected so as to improve Its usability for surveillance purposes.