Open Access Research article

Complicated malaria and other severe febrile illness in a pediatric ward in Libreville, Gabon

Marielle Karine Bouyou-Akotet12*, Denise Patricia Mawili-Mboumba12, Eric Kendjo12, Ariane Eyang Ekouma3, Omar Abdou Raouf3, Edouard Engohang Allogho3 and Maryvonne Kombila12

Author Affiliations

1 Department of Parasitology-Mycology, Faculty of medicine, Université des Sciences de la Santé, B.P.4009, Libreville, Gabon

2 Malaria Clinical and Operational Research Unit, Libreville, Gabon

3 Pediatric ward A, Centre Hospitalier de Libreville, Libreville, Gabon

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BMC Infectious Diseases 2012, 12:216  doi:10.1186/1471-2334-12-216

Published: 13 September 2012

Abstract

Background

Although a substantial decline of Plasmodium falciparum infection is observed in Africa following implementation of new control strategies, malaria is still considered as the major cause of febrile illness in hospitalized African children. The present study was designed to assess the management of febrile illness and to determine the proportion of children with febrile illness hospitalized for primary diagnosis of malaria who had confirmed complicated malaria after implementation of new malaria control strategies in Libreville, Gabon.

Methods

Demographic, clinical and biological data from hospitalized children with fever or a history of fever, with a primary diagnosis of clinical malaria, aged less than 18 years old, who benefited from hematological measurements and microscopic malaria diagnosis, were recorded and analyzed during a prospective and observational study conducted in 2008 in the Centre Hospitalier de Libreville.

Results

A total of 418 febrile children were admitted at hospital as malaria cases. Majority of them (79.4%) were aged below five years. After medical examination, 168 were diagnosed and treated as clinical malaria and, among them, only 56.7% (n = 95) had Plasmodium falciparum positive blood smears. Age above five years, pallor, Blantyre Coma Score ≤2 and thrombocytopenia were predictive of malaria infection. Respiratory tract infections were the first leading cause of hospitalization (41.1%), followed by malaria (22.7%); co-morbidities were frequent (22%). Less than 5% of suspected bacterial infections were confirmed by culture. Global case fatality rate was 2.1% and 1% for malaria. Almost half (46%) of the children who received antimalarial therapy had negative blood smears. Likewise, antibiotics were frequently prescribed without bacteriological confirmation.

Conclusions

The use of clinical symptoms for the management of children febrile illness is frequent in Gabon. Information, training of health workers and strengthening of diagnosis tools are necessary to improve febrile children care.