Pain in malaria: An assessment of its prevalence, characteristics and determinants in Ibadan, Nigeria

Abstract

Morbidity and mortality due to malaria in sub-Sahara Africa remains unacceptably high, slowing socioeconomic development in endemic communities. Pain is one reason why malaria-patients seek medical attention. However, pain due to malaria is often ignored, poorly evaluated and virtually un-studied. This study explored this pain among outpatients in Ibadan, Nigeria. This facility-based, cross-sectional survey conducted in Ibadan examined seven-hundred out-patients, aged ≥6years, with acute-uncomplicated-malaria. They were evaluated for the presence, quality, intensity and effects of pain using validated instruments incorporating the category and Wong-Baker faces scales. Data were summarized, tested for association at α=0.05 and a logistic regression model of covariates fitted to predict the risk of pain. Respondents’ mean age was 33.0±16.1years, 12.7% children, 66.6% females and 72.3% had “malaria pain”. The head (66.0% vs.72.8%), general muscular sites (17.0% vs.39.5%), abdomen (37.7% vs.11.4%) and joints (5.7% vs.17.0%) were the commonest localization of malaria-pain while, the character was aching in 91.9% vs.90.6%, intermittent pattern in 71.2% vs. 64.7% among children versus adults, respectively. At peak, pain-intensity was rated moderate and severe in 47.2% and 23.4% of respondents, able to completely interrupt work/school in 4.3%. Respondents’ gender, age-group, packed cell volume, using any antimalarial and non-usage of Artemisinin-based Combination Therapy had significant association with experiencing malaria-pain. This study highlighted pain as a significant symptom of malaria with higher risk in children, males, persons with hematocrit <30% and those not using artemisinin-based combination therapy. More attention needs to be paid to the assessment and effective treatment of malaria-pain.

Keywords: Acute-uncomplicated-malaria, Malaria-pain, Malaria-pain-intensity, Malaria-pain-character