Abstract:
BACKGROUND : It is believed that the current prevalence of malaria in endemic areas reflects selection for the carrier
form of sickle cell trait through a survival advantage. Malaria has been incriminated as a great cause of mortality in
people with sickle cell disease (SCD). However, people with SCD, a high-risk group, do not benefit from free or subsisized
malaria prevention and treatment in Cameroon unlike other vulnerable groups which may be due to insufficient evidence
to guide policy makers. This study aimed at describing clinical and socio-demographic characteristics of patients with
malaria, determining the prevalence of malaria in hospitalized children and in those with SCD and without, compare
frequency of presentation of malaria related complications (using clinical and laboratory elements that define severe
malaria) between children admitted for malaria with SCD and those without and finally, determing the risk factors for death
in children admitted for malaria.
METHODS : This was a retrospective analysis of admission records of children age 1 to 18 years with a confirmed malaria
diagnosis admitted at the Laquintinie Hospital during January 2015 through December 2018. Clinical features, laboratory
characteristics and outcome of malarial infections, stratified by SCD status were studied. Patients with HIV infection,
malnutrition, renal failure and discharged against medical advice were excluded from the study. Data were analysed using
Epi-info 7 software and analysis done. Chi square test, Odds ratios, CI and student’s t test were used to determine
association between variables. Statistical significance was set at p-value ≤0.05.
RESULTS : The prevalence of malaria was lower among children with SCD than it was among children without SCD (23.5%
vs 44.9%). Similarly, among those with a positive microscopy, the mean parasite density was significantly lower among
children with SCD than it was among children without SCD (22,875.6 vs 57,053.6 parasites/ μl with t-value − 3.2, p-value
0.002). The mean hemoglobin concentration was lower in SCD as compared to non SCD (5.7 g/l vs 7.4 g/l, t-value − 12.5,
p-value < 0.001). Overall mortality in SCD was 3.4% and malaria was reponsible for 20.4% of these deaths as compared to
the 35.4% in non SCD patients. Convulsion and impaired consciousness were significantly lower in SCD group (OR:0.1, CI:
0.1–0.3, p value < 0.01 and OR:0.1, CI:0.1–0.2, p-value < 0.001 respectively). Death was significantly higher in SCD patients
with malaria as compared to SCD patients admitted for other pathologies (3.2% vs 1.5%., OR:2.2, CI:1–5, p-value 0.050).
CONCLUSION : The SCD population has a lower mortality related to malaria compared to the non-SCD population.
Meanwhile, within the SCD population, those admitted with malaria are twice more likely to die than those admitted for
other pathologies. Jaundice, hepatomegaly and splenomegaly were common in SCD with malaria, however no risk factors
for malaria severity or malaria related death was identified.
