Factors Associated with Malaria Infection Among Febrile Patients Admitted to Emergency Units in Three Hospitals in Southern Benin: A Cross-Sectional Study
Mots-clés :
Malaria, Age under 15, LLINs, BeninRésumé
Background: Despite the scale-up of vector control interventions, malaria remains a leading cause of morbidity and mortality in Sub-Saharan Africa. In Benin, hospital-based data regarding the profile of severe malaria and the factors associated with infection in the context of widespread bed net coverage are crucial for evaluating control strategies. This study aimed to determine the prevalence of malaria, describe its clinical severity, and identify factors associated with infection among febrile patients admitted to three referral hospitals in Southern Benin.
Methods: We conducted a multicenter, prospective, cross-sectional study from October 9, 2023, to January 15, 2024. The study sites included the National Hospital University Center (CNHU-HKM), the Abomey-Calavi/Sô-Ava Zone Hospital (CHUZ-AS), and the Ouidah Zone Hospital (HZOD). The study population comprised febrile patients (temperature ≥38°C for children, ≥37.6°C for adults) aged over one year admitted to emergency wards. Malaria diagnosis was confirmed by Rapid Diagnostic Test (RDT) and/or thick blood smear. Multivariate logistic regression was used to identify independent risk factors. Avec quel logiciel et quelle est la taille d’échantillon ?
Results: A total of 366 febrile patients were enrolled. The overall prevalence of confirmed malaria was 38.3% (140/366). Among confirmed cases, 76.4% were classified as severe malaria according to WHO criteria. The most common signs of severity were severe anemia (57.0%), prostration (43.9%), and incoercible vomiting (33.6%). Age under 15 years was significantly associated with malaria (adjusted Odds Ratio [aOR]: 3.48; 95% CI: 1.32–14.2; p=0.02). Conversely, the reported use of Long-Lasting Insecticidal Nets (LLINs) was a significant protective factor (aOR: 0.26; 95% CI: 0.11–0.63; p=0.03).
Conclusion: Malaria remains a high-burden disease in emergency settings in Southern Benin, characterized by a predominance of severe forms, particularly severe anemia in children. The protective effect of LLINs highlights the continued need for vector control, while the age-related risk underscores the necessity for targeted pediatric interventions.
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Références
World Health Organization. World malaria report 2023. Geneva: World Health Organization; 2023.
Snow RW, Sartorius B, Kyalo D, et al. The prevalence of Plasmodium falciparum in sub-Saharan Africa since 1900. Nature. 2017;550(7677):515-518.
Padonou GG, Gbedjissi G, Yadouleton A, et al. Entomological indicators of malaria transmission in the health district of Ouidah-Kpomassè-Tori Bossito in southern Benin. Parasit Vectors. 2020;13(1):1-12.
Ministère de la Santé du Bénin. Annuaire des statistiques sanitaires 2021. Cotonou : SNIGS ; 2022.
Sachs J, Malaney P. The economic and social burden of malaria. Nature. 2002; 415:680–685.
World Health Organization. Global technical strategy for malaria 2016–2030. 2021 Update. Geneva: WHO; 2021.
Ministère de la Santé du Bénin. Plan Stratégique National de Lutte contre le Paludisme 2017-2021. Cotonou: PNLP; 2017.
Bhatt S, Weiss DJ, Cameron E, et al. The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature. 2015;526(7572):207-211.
Gnanguenon V, Azondekon R, Oke-Agbo F, et al. Evidence of man-vector contact in torn long-lasting insecticide-treated nets. BMC Public Health. 2013; 13:751.
Cohee LM, Opondo C, Clarke SE, et al. Preventive malaria treatment for school-aged children in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Glob Health. 2020;8(12): e1499-e1511.
Hounto A, Adé S, de Tove KM, et al. Severe malaria in children and adults at the Cotonou university hospital, Benin. Med Sante Trop. 2014;24(3):301-305.
Maze MJ, Bassat Q, Feasey NA, et al. The epidemiology of febrile illness in sub-Saharan Africa: implications for diagnosis and management. Clin Microbiol Infect. 2018;24(8):808-814.
Hopkins H, Bruxvoort KJ, Cairns ME, et al. Impact of rapid diagnostic tests on antimalarial use for fever: a systematic review and meta-analysis. BMJ Global Health. 2017;2: e000187.
Otu AA, Udoh UA, Ita OI, Hicks JP, Ukpeh I, Walley J. Prevalence of Zika and malaria in patients with fever in secondary healthcare facilities in south-eastern Nigeria. Trop Doct. 2020;50(1):22-30.
Sumbele IUN, Sama SO, Kimbi HK, Taiwe GS. Malaria, Moderate to Severe Anaemia, and Malarial Anaemia in Children at Presentation to Hospital in the Mount Cameroon Area: A Cross-Sectional Study. Anemia. 2016; 2016:5725634.
Tusting LS, Weiss DJ, Cameron E, et al. The mapping of urban malaria in Africa: A systematic review. Lancet Infect Dis. 2019;19(10): e357-e365.
Yadouleton A, N'Guessan R, Allagbé H, et al. The impact of the expansion of urban vegetable farming on malaria transmission in major cities of Benin. Parasit Vectors. 2010; 3:118.
Breman JG. The ears of the hippopotamus: manifestations, determinants, and estimates of the malaria burden. Am J Trop Med Hyg. 2001;64(1_suppl):1-11.
Menendez C, Fleming AF, Alonso PL. Malaria-related anaemia. Parasitol Today. 2000;16(11):469-476.
Idro R, Marsh K, John CC, Newton CR. Cerebral malaria: mechanisms of brain injury and strategies for improved neurocognitive outcome. Pediatr Res. 2010; 68:267–274.
Eleke ES, Lukusa PM, Abdala AK, Mpoy CW, Wembonyama SO. Part de l’anémie et du paludisme chez les enfants fébriles à Mbandaka, République Démocratique du Congo. J Med Public Health Policy Res. 2021 ;1(1) :27-30.
Degarege A, Erko B. Association between intestinal helminth infections and anemia in developing countries: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2016;10(12): e0005167.
Accrombessi M, Yovo E, Cottrell G, et al. Cohort profile: The BENin Eco-epidemiology of Malaria (BENEM) study. BMJ Open. 2018;8(2): e018746.
Damien GB, Djènontin A, Rogier C, et al. Malaria infection and disease in an area with pyrethroid-resistant vectors in southern Benin. Malar J. 2010; 9:380.
Tokponnon FT, Ogouyèmi-Hounto A, Sissinto Y, et al. Impact of long-lasting insecticidal nets on malaria transmission in Benin. Malar J. 2014; 13:364.
Yé Y, Kilian A, Eouzan I, et al. Mass distribution of long-lasting insecticidal nets and impact on malaria in Benin. Am J Trop Med Hyg. 2019;101(4).
Gleave K, Lissenden N, Richardson M, et al. Piperonyl butoxide (PBO) combined with pyrethroids in insecticide-treated nets to prevent malaria in Africa. Cochrane Database Syst Rev. 2021;5(5):CD010772.
Ngufor C, N'Guessan R, Boko P, et al. Efficacy of the Olyset Duo net against pyrethroid-resistant Anopheles gambiae from Southern Benin. Parasit Vectors. 2016; 9:143.
Doolan DL, Dobaño C, Baird JK. Acquired immunity to malaria. Clin Microbiol Rev. 2009;22(1):13-36.
Nkumama IN, O'Meara WP, Osier FH. Changes in malaria epidemiology in Africa and new challenges for elimination. Trends Parasitol. 2017;33(2):128-140.
Houngbedji CA, N'Dri PB, Hürlimann E, et al. Disparities in malaria burden among children in south-central Côte d'Ivoire. Parasit Vectors. 2015; 8:402.
Institut National de la Statistique et de l'Analyse Économique (INSAE) et ICF. Enquête Démographique et de Santé au Bénin (EDSB-V) 2017-2018. Cotonou : INSAE ; 2019.
Coldiron ME, Assao B, Page AL, et al. Malaria in the emergency department of a hospital in rural Niger: a prospective study. Malar J. 2017; 16:157.
Baume CA, Marin MC. Intra-household mosquito net use in Ethiopia, Ghana, Mali, Nigeria, Senegal, and Zambia: are nets being used? Am J Trop Med Hyg. 2007;77(5):963-971.
White NJ. Anaemia and malaria. Malar J. 2018;17(1):371.
Walldorf JA, Cohee LM, Coalson JE, et al. School-age children are a reservoir of malaria infection in Malawi. PLoS One. 2015;10(7): e0134061.
World Health Organization. WHO Guidelines for malaria. Geneva: World Health Organization; 2022.
Debash H, Bisetegn H, Ebrahim H, et al. Prevalence and associated risk factors of malaria among febrile under-five children visiting health facilities in Ziquala district, Northeast Ethiopia. PLoS One. 2022;17(10): e0276899.
Camara B, Diagne/Gueye NR, Faye PM, et al. Critères de gravité et facteurs pronostiques du paludisme chez l’enfant à Dakar. Med Mal Infect. 2011;41(2):63-67.
Mansour M, Samaila B, Lamine MM, et al. Facteurs associés au paludisme grave de l’enfant et son pronostic à l’hôpital National de Niamey, Niger. Med Afr Noire. 2019; 66:464-476.
