TY - JOUR
T1 - Severe malaria in Battambang Referral Hospital, an area of multidrug resistance in Western-Cambodia
T2 - A retrospective analysis of cases from 2006-2009
AU - Lon, Chanthap
AU - Timmermans, Ans
AU - Buathong, Nillawan
AU - Nou, Samon
AU - Se, Youry
AU - Sitthy, Ngo
AU - Chann, Soklyda
AU - Kraesub, Somporn
AU - Wongstitwilairoong, Tippa
AU - Walsh, Douglas S.
AU - Tyner, Stuart
AU - Fukuda, Mark
AU - Callender, David
AU - Sherwood, Jeffrey
AU - Koy, Lenin
AU - Char, Mengchour
AU - Bethell, Delia
AU - Saunders, David
N1 - Funding Information:
The authors thank the CNM and Director and staff of Battambang Referral Hospital, and the Global Emerging Infections Surveillance and Response System (a Division of the Armed Forces Health Surveillance Center) for financial support of this work. We are grateful to the patients included in this study and hope that the knowledge gained will contribute to a continuing decrease of severe malaria in Cambodia. The views expressed in this article are those of the authors and do not reflect the official policy of the US Department of the Army, Department of Defense, or the US Government.
PY - 2013
Y1 - 2013
N2 - Background: Despite recent malaria containment and control efforts leading to reduced incidence, Cambodia remains endemic for both Plasmodium vivax and multidrug-resistant Plasmodium falciparum malaria. Little has been reported in the peer-reviewed literature regarding the burden of severe malaria (SM) in Cambodia. Methods. Medical records for all patients admitted to the Battambang Referral Hospital (BRH) with an admitting or discharge diagnosis of SM from 2006 to 2009 (suspected SM cases) were reviewed. Those meeting the case definition of SM according to retrospective chart review and investigator assessment of probable cases, based on published national guidelines available at the time, were analysed for trends in demographics, mortality and referral patterns. Results: Of the 537 suspected SM cases at BRH during the study period, 393 (73%) met published WHO criteria for SM infection. Despite limited diagnostic and treatment facilities, overall mortality was 14%, with 7% mortality in children 14 and under, but 19% in adults (60% of cases). Cerebral malaria with coma was relatively rare (17%), but mortality was disproportionately high at 35%. Mean time to hospital presentation was five days (range one to 30 days) after onset of symptoms. While patients with delays in presentation had worse outcomes, there was no excess mortality based on treatment referral times, distance travelled or residence in artemisinin-resistance containment (ARC) Zone 1 compared to Zone 2. Conclusions: Despite limitations in diagnosis and treatment, and multiple confounding co-morbidities, mortality rates at BRH were similar to reports from other countries in the region. Interventions to improve access to early diagnosis and effective treatment, combined with modest improvements in intensive care, are likely to reduce mortality further. Patients referred from Zone 1 did not have excess mortality compared to Zone 2 ARC areas. A steep decrease in SM cases and deaths observed in the first half of 2009 has since continued, indicating some success from containment efforts despite the emergence of artemisinin resistance in this area.
AB - Background: Despite recent malaria containment and control efforts leading to reduced incidence, Cambodia remains endemic for both Plasmodium vivax and multidrug-resistant Plasmodium falciparum malaria. Little has been reported in the peer-reviewed literature regarding the burden of severe malaria (SM) in Cambodia. Methods. Medical records for all patients admitted to the Battambang Referral Hospital (BRH) with an admitting or discharge diagnosis of SM from 2006 to 2009 (suspected SM cases) were reviewed. Those meeting the case definition of SM according to retrospective chart review and investigator assessment of probable cases, based on published national guidelines available at the time, were analysed for trends in demographics, mortality and referral patterns. Results: Of the 537 suspected SM cases at BRH during the study period, 393 (73%) met published WHO criteria for SM infection. Despite limited diagnostic and treatment facilities, overall mortality was 14%, with 7% mortality in children 14 and under, but 19% in adults (60% of cases). Cerebral malaria with coma was relatively rare (17%), but mortality was disproportionately high at 35%. Mean time to hospital presentation was five days (range one to 30 days) after onset of symptoms. While patients with delays in presentation had worse outcomes, there was no excess mortality based on treatment referral times, distance travelled or residence in artemisinin-resistance containment (ARC) Zone 1 compared to Zone 2. Conclusions: Despite limitations in diagnosis and treatment, and multiple confounding co-morbidities, mortality rates at BRH were similar to reports from other countries in the region. Interventions to improve access to early diagnosis and effective treatment, combined with modest improvements in intensive care, are likely to reduce mortality further. Patients referred from Zone 1 did not have excess mortality compared to Zone 2 ARC areas. A steep decrease in SM cases and deaths observed in the first half of 2009 has since continued, indicating some success from containment efforts despite the emergence of artemisinin resistance in this area.
UR - http://www.scopus.com/inward/record.url?scp=84879458673&partnerID=8YFLogxK
U2 - 10.1186/1475-2875-12-217
DO - 10.1186/1475-2875-12-217
M3 - Article
C2 - 23802651
AN - SCOPUS:84879458673
SN - 1475-2875
VL - 12
JO - Malaria Journal
JF - Malaria Journal
IS - 1
M1 - 217
ER -