Hospital-based surveillance of malaria-related paediatric morbidity and mortality in Kinshasa, Zaire

Abstract

Although Plasmodium falciparum malaria is a leading cause of paediatric morbidity and mortality in Africa, few quantitative estimates are available about the impact of malaria on childhood health. To quantify the impact of the disease in an urban African setting, we reviewed the paediatric ward and mortuary records at Mama Yemo Hospital in Kinshasa, Zaire. From June 1985 to May 1986, 6208 children were admitted to the hospital, 2374 (38.2%) of whom had malaria; 500 of those with malaria died (case fatality rate, 21.1%). During this same period, there were 10,036 paediatric deaths, 1323 (13.2%) of which were attributed to malaria; 823 (62.2%) of these occurred in the emergency ward prior to hospitalization. Minimum population-based malaria mortality rates were highest for children aged less than 1 year (4.0 per 1000 per year). Over 70% of children admitted with malaria and greater than 80% of children who died from the disease were less than 5 years old. The total number of paediatric admissions and deaths remained relatively constant between 1982 and 1986; however, the proportional malaria admission rate increased from 29.5% in 1983 to 56.4% in 1986, and the proportional malaria mortality rate, from 4.8% in 1982 to 15.3% in 1986. These increases were temporally related to the emergence of chloroquine-resistant Plasmodium falciparum malaria in Kinshasa. Malaria is therefore a major cause of paediatric morbidity and mortality in the city, and this study indicates that hospital-based surveillance may be useful in monitoring disease-specific morbidity and mortality elsewhere in Africa.

PIP: The pediatric ward and mortuary records at Mama Yemo Hospital in Kinshasa, Zaire were studied in an attempt to estimate the impact of malaria-related pediatric morbidity and mortality. Although Plasmodium falciparum malaria is a frequent cause of pediatric mortality and morbidity, few students have been made to try estimate the effect of the disease on childhood survival. Of the 6208 children admitted to the 3 pediatric wards of Mama Yemo Hospital between in Mama Yemo Hospital, 2374 (38.2%) had malaria. Of those who had malaria, 70% were 5 years or younger. 500 of the 2374 hospitalized children with malaria died. This accounted for 13.2% of all pediatric deaths. A significant rise in the number of malaria admissions was observed between 1983 and 1984, but no one has pinpointed with any certainty the reason why. It appears that an acquired immunity to malaria develops among younger children and that the disease most dramatically affects infants. 62.2% of the pediatric deaths occurred in the emergency ward of the hospital. Fast and intense clinical management of the disease is essential to the survival of the children affected. Monitoring health care facilities and their abilities in the control of disease, will provide suggestions for improvements in health-care delivery programs that may positively affect malaria-related mortality.