Rosauro Varo1, Llorenç Quintó2, Antonio Sitoe3, Lola Madrid4, Sozinho Acácio5, Pio Vitorino6, Ana Marta Valente7, Alfredo Mayor8, Daniel Camprubí9, Jose Muñoz10, Gizela Bambo11, Eusebio Macete12, Clara Menéndez13, Pedro L Alonso14, Pedro Aide15, Quique Bassat16. 1. Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain. Electronic address: rosauro.varo@isglobal.org. 2. ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain. Electronic address: llorenc.quinto@isglobal.org. 3. Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique. Electronic address: antonio.sitoe@manhica.net. 4. Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: Lola.Madrid-Castillo@lshtm.ac.uk. 5. Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique. Electronic address: sozinho.acacio@manhica.net. 6. Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique. Electronic address: pio.vitorino@manhica.net. 7. Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain. Electronic address: marta.valente@manhica.net. 8. Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain. Electronic address: alfredo.mayor@isglobal.org. 9. ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain. Electronic address: dcamprub@clinic.cat. 10. ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain. Electronic address: jose.munoz@isglobal.org. 11. Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique. Electronic address: gizela.bambo@manhica.net. 12. Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique. Electronic address: eusebio.macete@manhica.net. 13. Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. Electronic address: clara.menendez@isglobal.org. 14. Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain. Electronic address: pedro.alonso@isglobal.es. 15. Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; National Institute of Health, Ministry of Health, Mozambique. Electronic address: pedro.aide@manhica.net. 16. Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain; Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain. Electronic address: quique.bassat@manhica.net.
Abstract
OBJECTIVES: This retrospective analysis performed in Manhiça, Southern Mozambique, aimed to describe the frequency of post-malarial anemia (measured as a decrease of hematocrit ≥10%) and the need for blood transfusions in children with severe malaria treated with intravenous quinine or parenteral artesunate. METHODS: All children <15 years admitted with a parasitologically-confirmed diagnosis of malaria from 1st January 2003 to 31st December 2017, alive at hospital discharge, and with at least one measurement of hematocrit within 28 days after hospital discharge, detected by passive case detection, were included. RESULTS: The overall prevalence of post-malarial anemia observed in the study was 23.13%, with an estimated incidence rate of 288.84 episodes/1,000 children-month at risk in the follow-up period (28 days after discharge). There were no differences between treatment groups, although the study showed a higher association between blood transfusions and artesunate treatment. CONCLUSIONS: In this setting, children with severe malaria frequently present a meaningful decrease of hematocrit (>=10%) in the first weeks after their episode, sometimes requiring blood transfusions. Because of the high underlying prevalence of anemia in malaria-endemic settings, all children with severe malaria need to be actively followed up, irrespective of the treatment received.
OBJECTIVES: This retrospective analysis performed in Manhiça, Southern Mozambique, aimed to describe the frequency of post-malarial anemia (measured as a decrease of hematocrit ≥10%) and the need for blood transfusions in children with severe malaria treated with intravenous quinine or parenteral artesunate. METHODS: All children <15 years admitted with a parasitologically-confirmed diagnosis of malaria from 1st January 2003 to 31st December 2017, alive at hospital discharge, and with at least one measurement of hematocrit within 28 days after hospital discharge, detected by passive case detection, were included. RESULTS: The overall prevalence of post-malarial anemia observed in the study was 23.13%, with an estimated incidence rate of 288.84 episodes/1,000 children-month at risk in the follow-up period (28 days after discharge). There were no differences between treatment groups, although the study showed a higher association between blood transfusions and artesunate treatment. CONCLUSIONS: In this setting, children with severe malaria frequently present a meaningful decrease of hematocrit (>=10%) in the first weeks after their episode, sometimes requiring blood transfusions. Because of the high underlying prevalence of anemia in malaria-endemic settings, all children with severe malaria need to be actively followed up, irrespective of the treatment received.