Congenital clinical malaria: Incidence, management and outcome as seen in the Usmanu Danfodiyo Univrsity Teaching Hospital, Sokoto in Nigeria

Abstract

Objective: With paucity of documentation of congenital clinical malaria in the world literature, we therefore aimed to review its rates, presentation, management and out come of this problem in neonates at the Usmanu Danfodiyo University Teaching Hospital, Sokoto.
Methodology: This prospective study was carried out in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria over a 10- month period; (January 2006 to October, 2006). The study populations were the admitted neonates to the emergency paediatric unit and the Special Care Baby Unit that presented with fever and other clinical features suggestive of malaria and/or septicaemia. Diagnosis of malaria was by Giemsa stain on blood smears and that of septicaemia was by positive blood culture.
Results: 162 babies [aged ≤28days] were admitted with fever amongst other clinical features during this period. 156 (96%) of the babies admitted, 82 (53%) were males, and 74 (47%) females, giving a M: F ratio of 1.2:1, and these were positive for malaria parasite alone. Of the babies with the specific morbidity of clinical neonatal malaria, 68(44%) were aged seven days or below, and were considered to be congenital. Our encountered incidence was high; 50 per 1000 live births. The mean (SD) birth weight was 2.76(0.28) kg, mean (SD) gestational age, 39.24 (1.18) weeks and mean (SD) temperature 38.4(0.5) 0 C.
Plasmodium falciparum trophozoites were the only species observed in this study. There was no recorded case of transfusion malaria. The postnatal age group of 0-7 days was the commonest age group at which the neonates were admitted. The distribution of malaria density was in favour of malaria density (+), 39(57%). Fever was the commonest (100%) presentation followed by refusal of feeds (93%) and irritability (76%). Of the 68 babies in the study group, 32(47%) were delivered to pimiparas.
The subjects were treated with arthemeter-lumenfantrine tablets for three days. No baby in the study group died. However, 6 babies that had both neonatal malaria and septicaemia died while, 5 babies that were negative for both malaria parasite and blood culture but with worsening clinical signs and persistent fever also died despite adequate treatment for possible septicaemia and malaria.
Conclusion: Although no mortality occurred in congenital clinical malaria, however, a diverse pattern of morbidity was shown. There is the need for continuing health education to increase the awareness amongst pregnant mothers of the importance of ante natal clinic visits for prescription of malaria chemoprophylaxis. The efficacy of artemether-lumefantrine combination in the treatment of clinical congenital malaria is strongly highlighted.


Sahel Medical Journal Vol. 10 (1) 2007: pp. 24-28