Severe malaria symptoms associated with plasmodium vivax among patients visiting health facilities in mendi town, oromiya regional state, western Ethiopia

Abstract

Malaria is a serious global health problem, a vector-borne infectious disease of humans and other animals caused by unicellular obligate intracellular protozoan parasites of the genus Plasmodium. Five primary species of malaria parasites infect humans. P. vivax malaria is usually an uncomplicated disease, which runs a benign course, changing trends with severe and life-threatening complications has been reported from different endemic regions. Thus, this study was designed to assess the occurrence of severe malaria complications (one or more complications that causes multi-organ dysfunction occurring in the absence of an identified alternative causes and in the presence of Plasmodium asexual parasite.) associated with P. vivax in Western parts of Ethiopia. Presumptive malaria patients of all age groups seeking medication at the selected health facilities in Mendi town were recruited for the study. Socio demographic, clinical and parasitological characteristics of uncomplicated and complicated malaria were assessed following standard procedures. Data were analyzed using IBM SPSS statistical software version 20. Median age of the participants was 14 years (from one month to 85 years). Geometric mean parasite count and mean hemoglobin level were 3745 parasite/μL and 12.4 g/dL, respectively. Among the 384 patients enrolled in the study based on the inclusion criteria for P. vivax mono-infection, 55 of them were fulfilled at least one of the WHO criteria for severe malaria indicators. Those fulfilled at least one of the WHO criteria for severe malaria syndromes were, 36 (65.5%), while 19 (34.5%) had two or more overlapping severity indicators. Some of these syndromes were: prostration 14 (25.45%), persistent vomiting 9 (16.36%), respiratory distress 6 (10.9%), hypoglycemia 5 (9.1%), hyperpyrexia 8 (14.5%), and severe anemia 13 (23.63%). In none of the cases symptoms such as epistaxis, confusion, coma, hemoglobinuria and hypotension were observed. Differences in parasite load did not affect the frequency of respiratory distress, hyperpyrexia, and hypoglycemia. However, severe anemia, prostration, and persistent vomiting were significantly affected (P<0.05) by relatively higher load of parasitemia (>10,000 parasite/µL), (OR=3.8, 95% CI, 1.1-13.7; OR=4.4, 95% CI, 1.4-13.9; and OR=7, 95% CI, 1.8-27.4) respectively. Similarly, these three severe malaria symptoms were significantly higher (P<0.01) in children <5 years. P. vivax malaria cases seems decreasing but from the total malaria burden its prevalent rate was high for instance the prevalence rate of P. vivax was 36.4%, 38% and 37.1% in the year 2010, 2012 and 2014 respectively. P.vivax associated severe malaria complications observed in this study participants strengthen the fact that this parasite will no longer be considered mild rather it is virulent. Thus, to meet international and regional targets for reduction of malarial mortality and morbidity, responsible bodies should no longer neglect the impact of P. vivax.