title: Association of HIV infection with the development of severe and complicated malaria cases at a rural hospital in Zimbabwe.
abstract: OBJECTIVE
  To determine the association between HIV infection and progression of Plasmodium falciparum malaria illness in Hurungwe district, Zimbabwe.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Hurungwe Rural Hospital in Mashonaland West Province, Zimbabwe.
  
  
  METHODS
  Blood slide positive P. falciparum malaria patients.
  
  
  METHODS
  Development of severe and complicated malaria.
  
  
  RESULTS
  A total of 659 clinical malaria cases were investigated and 237 (36.0%) confirmed cases entered the study. The total HIV positive malaria patients were 82 (34.6%) of confirmed cases or 12.4% of the total clinical cases. The case fatality rate was 5.9% (14 deaths) in the confirmed cases and 11 of these deaths were HIV positive. The commonly reported complications were high parasite count of 2% or more (38.5%), anaemia (29.0%), cerebral malaria (23.1%), low blood pressure (8.3%) and renal failure (1.2%). The HIV positive cases which developed severe and complicated malaria were 72, 30.4% of the sample studied or 55.8% of the total severe and complicated cases. The mode of transport to the nearest health centre was the only confounding factor identified during the analysis. After adjusting for this confounding factor, the risk of developing severe and complicated malaria was 2.35 (95% CI 1.85 to 2.98) times more in the HIV positive malaria patients than in HIV negative patients.
  
  
  CONCLUSIONS
  We conclude that HIV infection is significantly associated with the development of severe and complicated malaria. There is need for future studies to determine whether HIV positive malaria patients require different management protocol from HIV negative malaria patients.
authors.affiliation: Department of Community Medicine, University of Zimbabwe Medical School, P O Box A178, Avondale, Harare, Zimbabwe.
authors.forename: J
authors.initials: J
authors.lastname: Chirenda
authors.forename: S
authors.initials: S
authors.lastname: Siziya
authors.forename: M
authors.initials: M
authors.lastname: Tshimanga
mesh_terms: D000328:Adult; D000740:Anemia / Q000469:parasitology; D002423:Cause of Death; D015986:Confounding Factors, Epidemiologic; D018450:Disease Progression; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000453:epidemiology; D006780:Hospitals, Rural; D006801:Humans; D007022:Hypotension / Q000469:parasitology; D016779:Malaria, Cerebral / Q000469:parasitology; D016778:Malaria, Falciparum / Q000150:complications* / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000469:parasitology; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014187:Transportation of Patients / Q000706:statistics & numerical data; D015030:Zimbabwe / Q000453:epidemiology