Severe malaria in Battambang Referral Hospital, an area of multidrug resistance in Western-Cambodia: a retrospective analysis of cases from 2006–2009 View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2013-12

AUTHORS

Chanthap Lon, Ans Timmermans, Nillawan Buathong, Samon Nou, Youry Se, Ngo Sitthy, Soklyda Chann, Somporn Kraesub, Tippa Wongstitwilairoong, Douglas S Walsh, Stuart Tyner, Mark Fukuda, David Callender, Jeffrey Sherwood, Lenin Koy, Mengchour Char, Delia Bethell, David Saunders

ABSTRACT

BACKGROUND: Despite recent malaria containment and control efforts leading to reduced incidence, Cambodia remains endemic for both Plasmodium vivax and multidrug-resistant Plasmodium falciparum malaria. Little has been reported in the peer-reviewed literature regarding the burden of severe malaria (SM) in Cambodia. METHODS: Medical records for all patients admitted to the Battambang Referral Hospital (BRH) with an admitting or discharge diagnosis of SM from 2006 to 2009 (suspected SM cases) were reviewed. Those meeting the case definition of SM according to retrospective chart review and investigator assessment of probable cases, based on published national guidelines available at the time, were analysed for trends in demographics, mortality and referral patterns. RESULTS: Of the 537 suspected SM cases at BRH during the study period, 393 (73%) met published WHO criteria for SM infection. Despite limited diagnostic and treatment facilities, overall mortality was 14%, with 7% mortality in children 14 and under, but 19% in adults (60% of cases). Cerebral malaria with coma was relatively rare (17%), but mortality was disproportionately high at 35%. Mean time to hospital presentation was five days (range one to 30 days) after onset of symptoms. While patients with delays in presentation had worse outcomes, there was no excess mortality based on treatment referral times, distance travelled or residence in artemisinin-resistance containment (ARC) Zone 1 compared to Zone 2. CONCLUSIONS: Despite limitations in diagnosis and treatment, and multiple confounding co-morbidities, mortality rates at BRH were similar to reports from other countries in the region. Interventions to improve access to early diagnosis and effective treatment, combined with modest improvements in intensive care, are likely to reduce mortality further. Patients referred from Zone 1 did not have excess mortality compared to Zone 2 ARC areas. A steep decrease in SM cases and deaths observed in the first half of 2009 has since continued, indicating some success from containment efforts despite the emergence of artemisinin resistance in this area. More... »

PAGES

217

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/1475-2875-12-217

DOI

http://dx.doi.org/10.1186/1475-2875-12-217

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1008096436

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/23802651


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