STM Article Repository

Background: Malaria is a major public health problem in our countries where its distribution is similar to sickle cell disease. According to the latest world report on malaria, there are 249 million cases in 2022 with 608,000 deaths.

Children under 5 years old represent approximately 78% of all malaria deaths in WHO Africa Region where we find 94% of all malaria cases and 95% of deaths [16=1].

The relationship between sickle cell disease and malaria is the subject of much controversy. However, there is a lack of data on our services. Our objective was to study the epidemiological, diagnostic and evolutionary characteristics of malaria in children with sickle cell disease followed in a specialized setting.

Patients and Methods: We conducted a retrospective, descriptive, and analytical study of children with sickle cell disease (SCD) who presented with malaria and were followed at the Ambulatory Care Unit for Sickle Cell Children and Adolescents (USAD) at the Albert Royer National Children’s Hospital in Dakar, Senegal, West Africa from January 1st, 2017, to December 31st, 2019. We included all the following pediatric patients, less than 16 years, with sickle cell disease who presented at least one episode of malaria, confirmed by a positive thick drop, during these 3 years. We did not include patients with incomplete records or those older than 16 years. The clinical and biological signs, and the follow-up was collected and analyzed with Excel package 2019.

Results: Of 3773 patients followed for sickle cell disease, 21 had presented malaria. The frequency was 0.5% or 7 cases/year. However, we exploited the data of 14 of them. The sex ratio was 6 boys for a girl and the mean age at admission was 7.3 years. The highest number of malaria cases was observed in 2018 and the peak frequency was observed in November with 8 cases (57.1%). Fever was the most frequent symptom, observed in 10 patients (71.4%). All patients were SS homozygous, with a mean baseline hemoglobin level of 7.5g/dl. All patients had a positive thick blood smear and Plasmodium falciparum was the only species found in the blood smear, with a mean parasite density of 1693 parasites/ml of blood. All patients had anemia, with a mean hemoglobin level of 7.74 g/dl. Twelve patients (85.7%) were hospitalized and had all received inject- able artesunate followed by oral Artemisinin Combination Therapy (ACT). Long-lasting insecticidal nets were used in 9 patients (69.2%). The evolution was favorable in all patients, and any death was reported.

Conclusion: The patients who presented the association of malaria and sickle cell disease were all SS homozygotes. However, malaria must be considered as serious in this chronic anemic setting. That’s why it is important to improve prophylaxis. Therefore, it is important to make different strategies to reduce the global burden.