title: Prevalence, features and risk factors for malaria co-infections amongst visceral leishmaniasis patients from Amudat Hospital, Uganda.
abstract: METHODS
  Due to geographic overlap of malaria and visceral leishmaniasis (VL), co-infections may exist but have been poorly investigated. To describe prevalence, features and risk factors for VL-malaria co-infections, a case-control analysis was conducted on data collected at Amudat Hospital, Uganda (2000-2006) by Médecins sans Frontières. Cases were identified as patients with laboratory-confirmed VL and malaria at hospital admission or during hospitalization; controls were VL patients with negative malaria smears. A logistic regression analysis was performed to study the association between patients' characteristics and the occurrence of the co-infection.
  
  
  RESULTS
  Of 2414 patients with confirmed VL, 450 (19%) were positively diagnosed with concomitant malaria. Most co-infected patients were males, residing in Kenya (69%). While young age was identified by multivariate analysis as a risk factor for concurrent VL and malaria, particularly the age groups 0-4 (odds ratio (OR): 2.44; 95% confidence interval (CI): 1.52-3.92) and 5-9 years (OR: 2.23, 95% CI: 1.45-3-45), mild (OR: 0.53; 95% CI: 0.32-0.88) and moderate (OR: 0.45; 95% CI: 0.27-0.77) anemia negatively correlated with the co-morbidity. VL patients harboring skin infections were nearly three times less likely to have the co-infection (OR: 0.35; 95% CI: 0.17-0.72), as highlighted by the multivariate model. Anorexia was slightly more frequent among co-infected patients (OR: 1.71; 95% CI: 0.96-3.03). The in-hospital case-fatality rate did not significantly differ between cases and controls, being 2.7% and 3.1% respectively (OR: 0.87; 95% CI: 0.46-1.63).
  
  
  CONCLUSIONS
  Concurrent malaria represents a common condition among young VL patients living in the Pokot region of Kenya and Uganda. Although these co-morbidities did not result in a poorer prognosis, possibly due to early detection of malaria, a positive trend towards more severe symptoms was identified, indicating that routine screening of VL patients living in malaria endemic-areas and close monitoring of co-infected patients should be implemented.
authors.affiliation: Department of Biomedical Research, Royal Tropical Institute-KIT, Amsterdam, The Netherlands. E.v.d.Bogaart@kit.nl
authors.forename: Erika
authors.initials: E
authors.lastname: van den Bogaart
authors.forename: Marieke M Z
authors.initials: MM
authors.lastname: Berkhout
authors.forename: Emily R
authors.initials: ER
authors.lastname: Adams
authors.forename: Pètra F
authors.initials: PF
authors.lastname: Mens
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sentongo
authors.forename: Dawson B
authors.initials: DB
authors.lastname: Mbulamberi
authors.forename: Masja
authors.initials: M
authors.lastname: Straetemans
authors.forename: Henk D F H
authors.initials: HD
authors.lastname: Schallig
authors.forename: Francois
authors.initials: F
authors.lastname: Chappuis
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007898:Leishmaniasis, Visceral / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D008288:Malaria / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult