Prevalence and pattern of severe malaria among adults in Jimma University Specialized Hospital, Jimma, Southwest Ethiopia: A three years retrospective study

Abstract

Severe malaria is a protozoan disease of human caused mainly by plasmodium falciparum (P.falciparum) but sometimes by Plasmodium vivax and mixed infections. The objective was to assess the prevalence, pattern and trends of severe and complicated malaria among adults admitted to the Medical wards of Jimma University Specialized Hospital (JUSH), South West Ethiopia, from May 1, 2013 to April 30, 2016. A retrospective medical record review study was conducted from May 1, 2013 to April 30, 2016 to assesses the files and registries of patients’ with severe malaria admitted to Medical wards of JUSH. The prevalence of confirmed sever and complicated malaria in JUSH from May 1, 2013 to April 30, 2016 was 2.6 % (144) out of the total admission of 5590 patients cards in the three years to JUSH medical ward. Out of the confirmed severe and complicated malaria case mortality was 0.6 %( 32) with case fatality rate was 22.2 %( 32/144). Adult severe malaria cases showed slightly declining pattern during the study period: 90 %( 58) in 2013/14, 3.82% (33) in 2014/15 and 1.64% (53) in 2015/16. Distribution of cases over months showed bimodal pattern for all of the years with the two peaks during the months of May to July and during November to January. P. falciparum accounted for 91.6% of severe malaria causative agent. Patients with co-morbid infections account 33% of cases of severe and complicated malaria. The commonest co-morbid infection was meningitis. More than 80% of the cases were presented to the hospital after 24 hours of malaria episode, which may contributed to increased case fatality rate. Delayed hospital visit was significantly associated with average annual case fatality rate of 5.32 %(15.97% for all the study years) (X2=33.75, P=0.001).This study has shown that trend of malaria admission over three years showed marked decline from 2013/14 to 2015/16. Delay in presentation to the health facility is associated with poorer prognosis, hence early recognition and treatment would decrease mortality. Though declining pattern of malaria s being observed adult severe malaria transmission was active over the studied years even at the end of the first phase of Roll Back Malaria Initiative. Therefore, the efficiency of malaria control and treatment programs should be investigated to fill gaps.