title: Malaria in rural Mozambique. Part II: children admitted to hospital.
abstract: BACKGROUND
  Characterization of severe malaria cases on arrival to hospital may lead to early recognition and improved management. Minimum community based-incidence rates (MCBIRs) complement hospital data, describing the malaria burden in the community.
  
  
  METHODS
  A retrospective analysis of all admitted malaria cases to a Mozambican rural hospital between June 2003 and May 2005 was conducted. Prevalence and case fatality rates (CFR) for each sign and symptom were calculated. Logistic regression was used to identify variables which were independent risk factors for death. MCBIRs for malaria and severe malaria were calculated using data from the Demographic Surveillance System.
  
  
  RESULTS
  Almost half of the 8,311 patients admitted during the study period had malaria and 13,2% had severe malaria. Children under two years accounted for almost 60% of all malaria cases. CFR for malaria was 1.6% and for severe malaria 4.4%. Almost 19% of all paediatric hospital deaths were due to malaria. Prostration (55.0%), respiratory distress (41.1%) and severe anaemia (17.3%) were the most prevalent signs among severe malaria cases. Severe anaemia and inability to look for mother's breast were independent risk factors for death in infants younger than eight months. For children aged eight months to four years, the risk factors were malnutrition, hypoglycaemia, chest indrawing, inability to sit and a history of vomiting.MCBIRs for severe malaria cases were highest in children aged six months to two years of age. MCBIRs for severe malaria per 1,000 child years at risk for the whole study period were 27 in infants, 23 in children aged 1 to <5 years and two in children aged > or =5 years.
  
  
  CONCLUSIONS
  Malaria remains the number one cause of admission in this area of rural Mozambique, predominantly affecting young children, which are also at higher risk of dying. Measures envisaged to protect children during their first two years of life are likely to have a greater impact than at any other age.
authors.affiliation: Barcelona Center for International Health Research (CRESIB), Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Rosselló 132, E-08036 Barcelona, Spain. quique.bassat@manhica.net
authors.forename: Quique
authors.initials: Q
authors.lastname: Bassat
authors.forename: Caterina
authors.initials: C
authors.lastname: Guinovart
authors.forename: Betuel
authors.initials: B
authors.lastname: Sigaúque
authors.forename: Pedro
authors.initials: P
authors.lastname: Aide
authors.forename: Jahit
authors.initials: J
authors.lastname: Sacarlal
authors.forename: Tacilta
authors.initials: T
authors.lastname: Nhampossa
authors.forename: Azucena
authors.initials: A
authors.lastname: Bardají
authors.forename: Ariel
authors.initials: A
authors.lastname: Nhacolo
authors.forename: Eusébio
authors.initials: E
authors.lastname: Macete
authors.forename: Inácio
authors.initials: I
authors.lastname: Mandomando
authors.forename: John J
authors.initials: JJ
authors.lastname: Aponte
authors.forename: Clara
authors.initials: C
authors.lastname: Menéndez
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Alonso
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000818:Animals; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006780:Hospitals, Rural; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D015999:Multivariate Analysis; D010963:Plasmodium falciparum / Q000302:isolation & purification; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D011795:Surveys and Questionnaires