Association between malaria control and paediatric blood transfusions in rural Zambia: an interrupted time-series analysis View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2014-09-26

AUTHORS

Alison B Comfort, Janneke H van Dijk, Sungano Mharakurwa, Kathryn Stillman, Benjamin Johns, Payal Hathi, Sonali Korde, Allen S Craig, Nancy Nachbar, Yann Derriennic, Rose Gabert, Philip E Thuma

ABSTRACT

BACKGROUND: Blood transfusions can reduce mortality among children with severe malarial anaemia, but there is limited evidence quantifying the relationship between paediatric malaria and blood transfusions. This study explores the extent to which the use of paediatric blood transfusions is affected by the number of paediatric malaria visits and admissions. It assesses whether the scale-up of malaria control interventions in a facility catchment area explains the use of paediatric blood transfusions. METHODS: The study was conducted at a referral hospital for 13 rural health centres in rural Zambia. Data were used from facility and patient records covering all paediatric malaria admissions from 2000 to 2008. An interrupted time series analysis using an autoregression-moving-average model was conducted to assess the relationship between paediatric malaria outpatient visits and admissions and the use of paediatric blood transfusions. Further investigation explored whether the use of paediatric blood transfusions over time was consistent with the roll out of malaria control interventions in the hospital catchment area. RESULTS: For each additional paediatric malaria outpatient visit, there were 0.07 additional paediatric blood transfusions (95% CI 0.01-0.13; p < 0.05). For each additional paediatric admission for severe malarial anaemia, there were 1.09 additional paediatric blood transfusions (95% CI 0.95-1.23; p < 0.01). There were 19.1 fewer paediatric blood transfusions per month during the 2004-2006 malaria control period (95% CI 12.1-26.0; p < 0.01), a 50% reduction compared to the preceding period when malaria control was relatively limited. During the 2007-2008 malaria control period, there were 27.5 fewer paediatric blood transfusions per month (95% CI 14.6-40.3; p < 0.01), representing a 72% decline compared to the period with limited malaria control. CONCLUSIONS: Paediatric admissions for severe malarial anaemia largely explain total use of paediatric blood transfusions. The reduction in paediatric blood transfusions is consistent with the timing of the malaria control interventions. Malaria control seems to influence the use of paediatric blood transfusions by reducing the number of paediatric admissions for severe malarial anaemia. Reduced use of blood transfusions could benefit other areas of the health system through greater blood availability, particularly where supply is limited. More... »

PAGES

383

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/1475-2875-13-383

DOI

http://dx.doi.org/10.1186/1475-2875-13-383

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1050638327

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25261276


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24 schema:description BACKGROUND: Blood transfusions can reduce mortality among children with severe malarial anaemia, but there is limited evidence quantifying the relationship between paediatric malaria and blood transfusions. This study explores the extent to which the use of paediatric blood transfusions is affected by the number of paediatric malaria visits and admissions. It assesses whether the scale-up of malaria control interventions in a facility catchment area explains the use of paediatric blood transfusions. METHODS: The study was conducted at a referral hospital for 13 rural health centres in rural Zambia. Data were used from facility and patient records covering all paediatric malaria admissions from 2000 to 2008. An interrupted time series analysis using an autoregression-moving-average model was conducted to assess the relationship between paediatric malaria outpatient visits and admissions and the use of paediatric blood transfusions. Further investigation explored whether the use of paediatric blood transfusions over time was consistent with the roll out of malaria control interventions in the hospital catchment area. RESULTS: For each additional paediatric malaria outpatient visit, there were 0.07 additional paediatric blood transfusions (95% CI 0.01-0.13; p < 0.05). For each additional paediatric admission for severe malarial anaemia, there were 1.09 additional paediatric blood transfusions (95% CI 0.95-1.23; p < 0.01). There were 19.1 fewer paediatric blood transfusions per month during the 2004-2006 malaria control period (95% CI 12.1-26.0; p < 0.01), a 50% reduction compared to the preceding period when malaria control was relatively limited. During the 2007-2008 malaria control period, there were 27.5 fewer paediatric blood transfusions per month (95% CI 14.6-40.3; p < 0.01), representing a 72% decline compared to the period with limited malaria control. CONCLUSIONS: Paediatric admissions for severe malarial anaemia largely explain total use of paediatric blood transfusions. The reduction in paediatric blood transfusions is consistent with the timing of the malaria control interventions. Malaria control seems to influence the use of paediatric blood transfusions by reducing the number of paediatric admissions for severe malarial anaemia. Reduced use of blood transfusions could benefit other areas of the health system through greater blood availability, particularly where supply is limited.
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32 additional paediatric admission
33 additional paediatric blood transfusions
34 additional paediatric malaria outpatient visit
35 admission
36 analysis
37 anemia
38 area
39 association
40 availability
41 average model
42 blood availability
43 blood transfusion
44 catchment area
45 center
46 children
47 control
48 control interventions
49 control period
50 data
51 decline
52 evidence
53 extent
54 facilities
55 facility catchment areas
56 further investigation
57 greater blood availability
58 health centers
59 health system
60 hospital
61 hospital catchment area
62 interrupted time series analysis
63 intervention
64 investigation
65 limited evidence
66 limited malaria control
67 malaria
68 malaria admissions
69 malaria control
70 malaria control interventions
71 malaria control period
72 malaria outpatient visits
73 malaria visits
74 malarial anemia
75 model
76 months
77 mortality
78 number
79 outpatient visits
80 paediatric blood transfusions
81 paediatric malaria
82 paediatric malaria admissions
83 paediatric malaria outpatient visits
84 paediatric malaria visits
85 patient records
86 pediatric admissions
87 period
88 records
89 reduction
90 referral hospital
91 relationship
92 roll
93 rural Zambia
94 rural health centers
95 series analysis
96 severe malarial anemia
97 study
98 supply
99 system
100 time
101 time series analysis
102 timing
103 total use
104 transfusion
105 use
106 visits
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