title: Malaria among adult inpatients in two Tanzanian referral hospitals: a prospective study.
abstract: Most malaria research in sub-Saharan Africa has focused on children and pregnant women, but malaria among hospitalized adults in this region is poorly characterized. In this prospective study, we assessed the prevalence and clinical characteristics of malaria among the inpatient adults in two hospitals in Tanzania. We enrolled adults admitted with suspected malaria and performed routine thick blood smear (BS) and malaria rapid diagnostic tests (RDT). We also assessed malaria parasite clearance rates. We considered malaria status 'confirmed' or 'excluded' only in patients with two concordant tests. Malaria polymerase chain reaction (PCR) was performed in a subset of patients with discordant BS and RDT. After BS and RDT were performed on 579 adults with suspected malaria, malaria was excluded in 458/579 (79.1%) and confirmed in 16/579 (2.8%). One hundred and five out of 579 (18.1%) had discordant results. The prevalences of positive BS and positive RDT were 102/579 (17.6%) and 35/579 (6.0%), respectively, with only fair agreement (Kappa=0.354, p<0.0001). PCR results agreed with RDT in 35/35 (100%) of patients with a negative RDT but positive BS. PCR results also agreed with RDT in 9/13 (69.2%) of cases with a positive RDT but negative BS. Clinical correlates of malaria by multivariable analysis included subjective fever (OR 3.6 [1.0-12.3], p=0.04), headache (OR 3.1 [1.2-8.0], p=0.02) and vomiting (OR 2.7 [1.2-6.4], p=0.02). Malaria parasite clearance was significantly delayed in the HIV-infected group. Our study demonstrated only fair agreement between RDT and BS malaria tests among Tanzanian adult inpatients with suspected malaria. PCR generally agreed with RDT results. HIV was associated with delayed parasite clearance in adults with malaria. We recommend the routine use of RDTs for malaria diagnosis among adults admitted to hospitals in sub-Saharan Africa.
authors.affiliation: Catholic University of Health and Allied Sciences, PO Box 1464, Mwanza, Tanzania; Bugando Medical Centre, PO Box 1370, Mwanza, Tanzania. Electronic address: sekipcb@yahoo.com.
authors.forename: Semvua B
authors.initials: SB
authors.lastname: Kilonzo
authors.affiliation: Catholic University of Health and Allied Sciences, PO Box 1464, Mwanza, Tanzania.
authors.forename: Erasmus
authors.initials: E
authors.lastname: Kamugisha
authors.affiliation: Catholic University of Health and Allied Sciences, PO Box 1464, Mwanza, Tanzania; Bugando Medical Centre, PO Box 1370, Mwanza, Tanzania; Weill Cornell Medical College, NY, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Downs
authors.affiliation: Catholic University of Health and Allied Sciences, PO Box 1464, Mwanza, Tanzania; Bugando Medical Centre, PO Box 1370, Mwanza, Tanzania.
authors.forename: Johannes
authors.initials: J
authors.lastname: Kataraihya
authors.affiliation: Sekou Toure Regional Referral Hospital, PO Box 132, Mwanza, Tanzania.
authors.forename: Rwakyendela
authors.initials: R
authors.lastname: Onesmo
authors.affiliation: Catholic University of Health and Allied Sciences, PO Box 1464, Mwanza, Tanzania; Bugando Medical Centre, PO Box 1370, Mwanza, Tanzania.
authors.forename: Koy
authors.initials: K
authors.lastname: Mheta
authors.affiliation: Weill Cornell Medical College, NY, USA.
authors.forename: Jiyeon M
authors.initials: JM
authors.lastname: Jeong
authors.affiliation: Laboratory of Medical Microbiology and Immunology, St. Elisabeth Hospital, Tilburg, The Netherlands.
authors.forename: Jaco J
authors.initials: JJ
authors.lastname: Verweij
authors.affiliation: Weill Cornell Medical College, NY, USA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Fitzgerald
authors.affiliation: Catholic University of Health and Allied Sciences, PO Box 1464, Mwanza, Tanzania; Bugando Medical Centre, PO Box 1370, Mwanza, Tanzania; Weill Cornell Medical College, NY, USA.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Peck
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006761:Hospitals; D006801:Humans; D007297:Inpatients; D008288:Malaria / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008853:Microscopy / Q000379:methods*; D008875:Middle Aged; D010274:Parasitology / Q000379:methods*; D016133:Polymerase Chain Reaction / Q000379:methods*; D015995:Prevalence; D011446:Prospective Studies; D013636:Tanzania / Q000453:epidemiology
keywords: Adults; Clearance; Diagnosis; Malaria; Predictors; Tanzania