Hospitalization and ambulatory care in imported-malaria: evaluation of trends and impact on mortality. A prospective multicentric 14-year observational study

Abstract

Background: Hospitalization is usually recommended for imported malaria. The goal of the present study is to evaluate the evolution in clinical pathways while measuring their impact on mortality.

Methods: This is a 14-year prospective observational study divided into three periods. We evaluated for adult (≥15 years) and paediatric (<15 years) case trends in severity, clinical pathways (hospitalization in medical ward (MW) or intensive care unit (ICU), ambulatory care) and mortality.

Results: In total, 21,386 imported malaria cases were included, 4269 of them were paediatrics (20 %). Rises in severe forms for adults [from 8 % in period 1-14 % in period 3 (p = 0.0001)] and paediatrics [from 12 to 18 % (p < 0.0001)] were found. For adults, MW admission rates decreased [-15 % (CI 95 % -17; -13)] while ambulatory care [+7 % (CI 95 % 5-9)] and ICU admission rates [+4 % (CI 95 % 3-5)] increased. For paediatrics, increase in ICU admissions (+3 %) was shown. We did not observe any change in overall mortality during the study periods, whether among adults or children, regardless of care pathway.

Conclusions: The present study indicates a changing management of imported malaria in adults, with an increasing trend for ambulatory care. The absence of change in mortality for adults indicates that ambulatory care can be proposed for adults presenting non-severe imported malaria.

Keywords: Ambulatory care; Hospitalization; Imported malaria; Intensive care; Mortality.

Fig. 1

Trends in the proportion of hospitalization in medical ward during the study period among malaria cases reported in Ile-de-France, 2000–20,013, by month, according to age group. The number reported above the curve is the observed proportion for each period (Period 1: 2000–2003, Period 2: 2004–2008, Period 3: 2009–2013). The figure shows the proportion of patients with malaria cases hospitalized in the general Medical Ward, by month, among cases reported to the CNR between January 1st, 2000 and December 31, 2013 (black lines), smoothed with a 2^° polynomial regression line (red lines), in adults (a) and pediatric cases (b). Dotted red lines represent limits between the three study periods. Proportions are specified for each period

Fig. 2

Trends in the proportion of hospitalization in intensive care units during the study period among malaria cases reported in Ile-de-France, 2000–20,013, by month, according to age group. The number reported above the curve is the observed proportion for each period (Period 1: 2000–2003, Period 2: 2004–2008, Period 3: 2009–2013). The figure shows the proportion of patients with malaria cases hospitalized in ICU, by month, among cases reported to the CNR between January 1st, 2000 and December 31, 2013 (black lines), smoothed with a 2^° polynomial regression line (red lines), in adults (a) and pediatric cases (b). Dotted red lines represent limits between the three study periods. Proportions are specified for each period