The authors declare that they have no competing interests.
DF-R, OS and WAA conceived, designed, deployed and directed the case-controlled study at the Childhood Malaria Research Group, Ibadan, Nigeria. WAA, BJB, AEO, NKA, SO, KO, FOA, WAS, OS and DF-R carried out patient recruitment and follow-up, sample collection, storage and transport. WAA, FAO, JIA carried out haemoglobinuria tests. WAA, BJB, AEO, OS and DF-R analyzed data. DF-R, OS and WAA produced figures and tables and wrote the manuscript. All authors read and approved the final manuscript.
Haemoglobinuria is one of the manifestations of severe malaria and results from severe intravascular haemolysis. Glucose-6-phosphate dehydrogenase (G6PD) deficiency has been implicated in its aetiology. Haemoglobinuria may be associated with severe anaemia and, less frequently, acute renal failure.
A prospective case-control study was carried out to determine the incidence of haemoglobinuria as confirmed by dipstick urinalysis, microscopy and spectrophotometric measurement, among children with severe malaria. A total of 251 children presenting at the Children’s Emergency Ward with severe malaria were recruited over a period of 21 months. The G6PD status and the outcomes of severe malaria in children with and without haemoglobinuria was studied with respect to renal failure, the recurrence of haemoglobinuria and blood pressure changes over a three-month follow-up period.
It was found that the incidence of haemoglobinuria among children with severe malaria is 19.1%. Children <5 years constituted 76.8% of all the study patients. Patients with haemoglobinuria had median age of 52.5 months, which was significantly higher than 35 months in patients without haemoglobinuria (p=0.001). Although, haemaglobinuria was commoner among boys (54.2%) than girls (45.8%), the difference was not statistically significant. There were no significant differences between children with and without haemoglobinuria regarding their nutritional status or parasite densities. Among the clinical features of the study patients, only jaundice was significantly associated with haemoglobinuria (p=0.0001). Renal failure occurred in three out of 48 children with haemoglobinuria and in none of the 203 without. There was not recurrence of haemoglobinuria in the follow-up period. At discharge, blood pressure was elevated in six children (one previously haemoglobinuric), but all returned to normal within the follow-up period.
Haemoglobinuria was a prominent feature of severe malaria and it was significantly associated with jaundice at presentation. Haemoglobinuria was commoner in older children than younger children but not related to sex. G6PD deficiency was not an independent predictor of the occurrence or outcome of haemoglobinuria. Blood pressure was not affected by haemoglobinuria on admission nor during follow-up.
Adeyokunnu AA, Taiwo O, Antia AU: Childhood mortality among 22,255 consecutive admission in the University College Hospital, Ibadan. Nigerian Journal of Paediatrics. 1980, 1: 7-15.
Ceesay SJ, Casals-Pascual C, Erskine J, Anya SE, Duah NO, Fulford AJ, Sesay SS, Abubakar I, Dunyo S, Sey O, Palmer A, Fofana M, Corrah T, Bojang KA, Whittle HC, Greenwood BM, Conway DJ: Changes in malaria indices between 1999 and 2007 in the Gambia: a retrospective analysis. Lancet. 2008, 372: 1545-1554. 10.1016/S0140-6736(08)61654-2. PubMedCentralCrossRefPubMed
National Antimalaria Treatment Guidelines. National Antimalaria Treatment Guidelines. 2005, Federal Ministry of Health, Abuja-Nigeria, 1-52.
Severe falciparum malaria. World Health Organization, Communicable Diseases Cluster. Trans R Soc Trop Med Hyg. 2000, 94 (Suppl 1): S1-S90.
Banzal S, Ayoola EA, El Sammani EE, Gadour MO, Jain AK: The clinical pattern and complications of severe malaria in the Gizan region of Saudi Arabia. Ann Saudi Med. 1999, 19: 378-380. PubMed
Newton CR, Taylor TE, Whitten RO: Pathophysiology of fatal falciparum malaria in African children. Am J Trop Med Hyg. 1998, 58: 673-683. PubMed
WHO: Clinical, behavioural and socioeconomic factors related to severe malaria. A multicentre study in the African Region. 2002, World Health Organization
Sabine G, Bala YH, Suleimon M, Gunnar H: Malaria prevalence and outcome in the in-patients of the Paediatrics Department of the State Specialist Hospital (SSH), Maiduguri, Nigeria. J Trop Paed. 1998, 44: 109-113. 10.1093/tropej/44.2.109. CrossRef
Ahmed I, Olowe O: Haemoglobinuria in Nigerian children. Afr J Med Sci. 1971, 2: 101-108. PubMed
Chalmers AH, Snell LE: Estimation of plasma and urinary hemoglobin by a rate spectrophotometric method. Clin Chem. 1993, 39: 1679-1682. PubMed
Federal Republic of Nigeria Official Gazzette. Official Gazzette. 2007, Nigeria, B194-B195.
Beutler E, Mitchell M: Special modifications of the fluorescent screening method for glucose-6-phosphate dehydrogenase deficiency. Blood. 1968, 32: 816-818. PubMed
Mockenhaupt FP, Ehrhardt S, Burkhardt J, Bosomtwe SY, Laryea S, Anemana SD, Otchwemah RN, Cramer JP, Dietz E, Gellert S, Bienzle U: Manifestation and outcome of severe malaria in children in northern Ghana. Am J Trop Med Hyg. 2004, 71: 167-172. PubMed
Hendrickse RG, Hasan AH, Olumide LO, Akinkunmi A: Malaria in early childhood. An investigation of five hundred seriously ill children in whom a “clinical” diagnosis of malaria was made on admission to the children’s emergency room at University College Hospital, Ibadan. Ann Trop Med Parasitol. 1971, 65: 1-20. PubMed
Ayoola OO, Orimadegun AE, Akinsola AK, Osinusi K: A five-year review of childhood mortality at the University College Hospital, Ibadan. West Afr J Med. 2005, 24: 175-179. PubMed
Giha HA, Elghazali G, A-Elgadir TME, A-Elbasit IE, Eltahir EM, Baraka OZ, Khier MM, Adam I, Troye-Blomberg M, Theander TG, Elbashir MI: Clinical pattern of severe Plasmodium falciparum malaria in Sudan in an area characterized by seasonal and unstable malaria transmission. Trans R Soc Trop Med Hyg. 2005, 99: 243-251. 10.1016/j.trstmh.2004.04.002. CrossRefPubMed
- Haemoglobinuria among children with severe malaria attending tertiary care in Ibadan, Nigeria
Wasiu A Ajetunmobi
Adebola E Orimadegun
Biobele J Brown
Nathaniel K Afolabi
Folorunso A Olabiyi
John I Anetor
Felix O Akinbami
Wuraola A Shokunbi
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
e.Med Kampagnen-Visual, Mail Icon II