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In-Hospital Morbidity and Mortality Due to Severe Malarial Anemia in Western Kenya

Severe malarial anemia (SMA) is a leading cause of pediatric morbidity, hospitalization, and mortality in sub-Saharan Africa, and yet its contribution to malaria-specific mortality is not well documented. We retrospectively reviewed the clinical records of 1,116 children < 5 years of age admitted to Siaya district hospital, western Kenya, to assess the contribution of SMA to overall in-hospital mortality. Of 1,116 admissions, 86% were under 3 years, 83% had malaria parasitemia, 86% were anemic, 21% were severely anemic, and 20% were transfused. Severe anemia was associated with parasitemia in 85% of the admissions and contributed to 53% of malaria-related deaths. Overall, 83 (7.5%) children died; 66% of those deaths were malaria-related, 12% had severe anemia, and 89% were under 3 years. Transfusion did not lower mortality rates. In areas of high malaria transmission, children below 3 years are a high-risk group for malaria, anemia, blood transfusion, and mortality.

Received August 21, 2006. Accepted for publication March 7, 2007.

Acknowledgments: This study was financially supported by an Operational Research grant from World Health Organization, Regional Office for Africa. The authors thank the Director, Kenya Medical Research Institute for permission to publish these results.

^* Address correspondence to Charles O. Obonyo, Centre for Vector Biology & Control Research, Kenya Medical Research Institute, P.O. Box 1578, Kisumu 40100, Kenya. E-mail: Cobonyo{at}kisian.mimcom.net

Authors’ addresses: Charles O. Obonyo and John M. Vulule, Centre for Vector Biology & Control Research, Kenya Medical Research Institute, P.O. Box 1578, Kisumu, Kenya 40100. E-mails: Cobonyo{at}kisian.mimcom.net and JVulule{at}kisian.mimcom.net. Willis S. Akhwale, Division of Malaria Control, Kenyan Ministry of Health, P.O. Box 20750, Nairobi, Kenya, E-mail: wilak4{at}yahoo.com. Diederick E. Grobbee, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands, E-mail: D.E.Grobbee{at}umcutrecht.nl

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