Factors associated with decreased survival from neonatal malaria infection in Jos, North Central Nigeria.

ABSTRACT

BACKGROUND: Malaria is a serious cause of morbidity and mortality in the neonatal period and account for a significant number of fetal wastage. Its diagnosis is difficult because of the overlap in clinical presentation with other infectious disease in the neonatal period. This study set out to examine the factors that are associated with an increased risk of mortality in neonates admitted with malaria. METHOD: Forty one neonates presenting between January and June 2009 were enrolled after obtaining ethical approval and informed consent from the mothers. Information collected include gestational age, age at presentation, birth weight, clinical symptoms, associated medical conditions and pertinent pregnancy history. RESULTS: Of the 41 neonates studied, 24 (58.5%) were females, 29 (70.5%) were term neonates and 12 (29.3%) had low birth weight. Overall mortality was 24.4%, more male neonates (70%) had malaria compared to females (50.0%) and neonatal malaria was associated with a longer hospital stay (p < 0.001). Female neonates (RR = 0.81, CI = 0.69 0.95), neonatal malaria (RR = 0.63, CI = 0.54 0.73) and maternal negative HIV status (RR = 0.22, CI = 0.15 0.32) was associated with lower risk of mortality. Whereas, multiple symptoms at presentation (RR = 1.67, CI = 1.42 1.96), multiple medical conditions (RR = 1.59, CI = 1.37 1.84) and maternal malaria in pregnancy (RR = 1.54, CI = 1.23 1.29) were associated with increased risk of mortality. Maternal IPT use, gestational age and birth weight did not have any statistically significant relationship with mortality. CONCLUSION: Neonatal malaria is a significant cause of neonatal mortality; the risk of which is higher with the presence of other co-morbid factors. We suggest a review of the IPT program and the introduction of maternal malaria screening at time of delivery.