dc.contributor.author | Mithwani, Mohammed S | |
dc.date.accessioned | 2013-06-06T09:25:24Z | |
dc.date.available | 2013-06-06T09:25:24Z | |
dc.date.issued | 2003-07 | |
dc.identifier.citation | Mithwani, M.S(2003). Haemozoin is Not Associated with Severe Disease and Poor Outcome in Kenyan Children Admitted to a Coastal District Hospital | en |
dc.identifier.uri | http://erepository.uonbi.ac.ke:8080/xmlui/handle/11295/29099 | |
dc.description | Master of medicine Thesis | en |
dc.description.abstract | Malaria pigment (haemozoin) is the insoluble end product of haemoglobin digestion by the
malaria parasite P Jalciparum. This is phagocytosed by the mononuclear and
polymorphonuclear cells of the body which leads to the impairment of their immunological
function as described in various in-vitro studies. The clinical association of haemozoin with
severe malaria has been described but there has not been any study looking at the
association of haemozoin with syndrome-directed approach to severity of illness and
outcome due to any cause in children admitted to hospital. This retrospective cohort study
describes the association of haemozoin with severity of illness of any cause and outcome
comprising of various demographic, clinical and laboratory parameters in children
admitted to Kilifi District Hospital over a period of one year. A Giemsa stained peripheral
blood smear for malaria parasitaemia quantification was used to count pigment.
Of the 4192 children satisfying the entry criteria 33.8% had pigment and 50.4% had
parasitaemia on blood slide. Severe disease was seen in 34% and severe anaemia in 12.3%.
Pathogenic bacteria from blood cultures were isolated in 6.2% with Streptococcus being the
commonest organism. Salmonella was the 3rd commonest organism. Mortality was 5.8% of
whom children with malaria comprised 16%.
Of a subset of variables from the univariate analysis, a logistic regression model showed
that severe anaemia (OR 2.8,95% CI 2.2-3.8), hyperlactataemia (OR 2.7, 95% CI 1.9-3.8)
and Salmonella spp. bacteraemia (OR 5.0,95% CI 2.0-12.9) were independently associated
with the presence of pigment.
Malaria Pigment
A sub-analysis, stratified by parasitaemia, showed that severe anaemia, a raised WBC
count and Salmonella spp. bacteraemia were independently associated with the presence of
pigment.
A further analysis of children with a primary final diagnosis of malaria showed that coma,
prostration, respiratory distress and hypoglycaemia were independently associated with
poor outcome.
There was no association between pigment and mortality or severity of illness in our
analysis. However, pigment may have a role to play in the pathogenesis of malarial
anaemia and invasive Salmonella infection. | en |
dc.language.iso | en | en |
dc.subject | Haemozoin | en |
dc.subject | Severe disease | en |
dc.subject | Kenyan Children | en |
dc.subject | Coastal District Hospital | en |
dc.title | Haemozoin is not associated with severe disease and poor outcome in kenyan children admitted to a Coastal District Hospital | en |
dc.type | Thesis | en |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |
local.publisher | Department of paediatrics, University of Nairobi | en |