Clinical aspects and outcomes of patients with malaria at Chris Hani Baragwaneth Academic Hospital

Abstract

Background. South Africa (SA) is currently experiencing a significant increase in malaria cases despite having shifted focus from malaria control towards malaria elimination. The clinical features of malaria are non-specific, but the relative frequency on presentation are not well described. There are important interactions between human immunodeficiency virus (HIV) infection and malaria, including a high mortality associated with both diseases in Sub-Saharan Africa.Aim. To describe the population characteristics, clinical and biochemical features of severity, the proportion of participants with HIV infection and the management and outcomes of participants with malaria at Chris Hani Baragwanath Academic Hospital (CHBAH). Methods. A prospective observational study was conducted whereby patients with a confirmed laboratory diagnosis of malaria were identified, approached and consented for study inclusion over the time period from January 2017 to January 2018. Clinical and biochemical data were collected at the time of consent and later analysed.Results. The mean age was 35.7 years of age (SD=12.98) and 72 (70.6%) of the 102 participants were male. Peak admissions for malaria were in January where 58 (56.9%) participants were admitted during January 2017/2018. All malaria cases were imported with 75% associated with travel to Mozambique. The majority of participants (62%) were expatriates living in SA. The most common presenting symptoms were chills (95%), weakness (94%,), fever (91%), headache (90%) and lethargy (88%). The most common clinical signs were dehydration (31%), prostration (20%) and jaundice (14%). The number of participants with severe malaria was 40(39.2%), with prostration as the most common feature of severity (20%). ICU admission occurred in 8 participants (7.8%) and 6 participants (5.9%) required haemodialysis. The median duration of stay was 5 days (IQR=3). HIV status was known in 83 (81.4%) participants, of these 32 (38.6%) were found to be HIV positive. Malaria prophylaxis was taken by only 8 participants. The all-cause mortality rate was 4.9%, and mortality attributable to malaria was 3.9% Conclusion. This study showed a high proportion of complicated malaria cases, particularly in January. The majority of participants were young expatriate males with a travel history to southern Mozambique or Limpopo with very few taking malaria prophylaxis. Most clinical signs and symptoms were constitutional and non-specific. A large number of participants were found to be HIV positive and most were newly diagnosed. The mortality was high at around five times the national average, and was possibly an underestimate.