Anderson Coutinho da Silva, Elisabeth Carmem Duarte, Paola Barbosa Marchesini, Giselle Maria Rachid Viana, Walter Massa Ramalho, Klauss K S Garcia
{"title":"巴西非流行地区因严重疟疾而住院的相关因素：2011年至2019年亚马逊外地区的病例对照研究","authors":"Anderson Coutinho da Silva, Elisabeth Carmem Duarte, Paola Barbosa Marchesini, Giselle Maria Rachid Viana, Walter Massa Ramalho, Klauss K S Garcia","doi":"10.1186/s12936-025-05357-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Malaria is infectious disease with low occurrence in Brazil extra-Amazon Region. Despite this, higher lethality is observed in this region compared to the country's endemic area. Therefore, this study aimed to analyse factors associated with malaria hospitalizations (severe malaria) in the extra-Amazon Region, in order to prevent deaths.</p><p><strong>Methods: </strong>A case-control design was used, utilizing data from the Brazilian Notifiable Diseases Information System (Sinan) and hospitalization records from the Unified Health System (SIH/SUS) from 2011 to 2019. Cases comprised hospitalized malaria patients, while controls included reported malaria notifications without hospitalization. Probabilistic record linkage techniques were employed, and associations were analysed using multiple logistic regression with a 0.05 significance level.</p><p><strong>Results: </strong>The main risk factors identified were: Black or mixed-race ethnicity (OR = 1.22; 95% CI 1.04-1.43), low education (elementary school OR = 2.21; 95% CI 1.78-2.75 or high school OR = 1.72; 95% CI 1.39-2.13), infection outside the extra-Amazon Region (Amazon Region OR = 1.50; 95% CI 1.15-1.96 or abroad OR = 1.72; 95% CI 1.28-2.32), high parasite count (501 to 10,000/mm<sup>3</sup> OR = 1.51; 95% CI 1.27-1.80, 10,001 to 100,000/mm<sup>3</sup> OR = 1.77; 95% CI 2.87-1.96 or higher than 100,000/mm<sup>3</sup> OR = 3.15; 95% CI 2.20-4.50) and delayed treatment (after 3-7 days symptoms onset OR = 1.74; 95% CI 1.36-2.24 or 8 days or more OR = 2.08; 95% CI 1.62-2.66). Active case detection was a protective factor (OR = 0.65; 95% CI 0.54-0.78).</p><p><strong>Conclusions: </strong>Delayed treatment remains a key factor in the occurrence of severe malaria, leading to high parasitaemia and revealing inequalities in access to healthcare based on socioeconomic differences. Travel to the Amazon Region or other countries also poses a challenge, requiring strengthened traveller health strategies and increased surveillance awareness to promptly suspect and identify cases.</p>","PeriodicalId":18317,"journal":{"name":"Malaria Journal","volume":"24 1","pages":"227"},"PeriodicalIF":3.0000,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12255989/pdf/","citationCount":"0","resultStr":"{\"title\":\"Factors associated with hospitalizations due to severe malaria in the non-endemic Brazilian region: a case-control study in the extra-Amazon Region from 2011 to 2019.\",\"authors\":\"Anderson Coutinho da Silva, Elisabeth Carmem Duarte, Paola Barbosa Marchesini, Giselle Maria Rachid Viana, Walter Massa Ramalho, Klauss K S Garcia\",\"doi\":\"10.1186/s12936-025-05357-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Malaria is infectious disease with low occurrence in Brazil extra-Amazon Region. Despite this, higher lethality is observed in this region compared to the country's endemic area. Therefore, this study aimed to analyse factors associated with malaria hospitalizations (severe malaria) in the extra-Amazon Region, in order to prevent deaths.</p><p><strong>Methods: </strong>A case-control design was used, utilizing data from the Brazilian Notifiable Diseases Information System (Sinan) and hospitalization records from the Unified Health System (SIH/SUS) from 2011 to 2019. Cases comprised hospitalized malaria patients, while controls included reported malaria notifications without hospitalization. Probabilistic record linkage techniques were employed, and associations were analysed using multiple logistic regression with a 0.05 significance level.</p><p><strong>Results: </strong>The main risk factors identified were: Black or mixed-race ethnicity (OR = 1.22; 95% CI 1.04-1.43), low education (elementary school OR = 2.21; 95% CI 1.78-2.75 or high school OR = 1.72; 95% CI 1.39-2.13), infection outside the extra-Amazon Region (Amazon Region OR = 1.50; 95% CI 1.15-1.96 or abroad OR = 1.72; 95% CI 1.28-2.32), high parasite count (501 to 10,000/mm<sup>3</sup> OR = 1.51; 95% CI 1.27-1.80, 10,001 to 100,000/mm<sup>3</sup> OR = 1.77; 95% CI 2.87-1.96 or higher than 100,000/mm<sup>3</sup> OR = 3.15; 95% CI 2.20-4.50) and delayed treatment (after 3-7 days symptoms onset OR = 1.74; 95% CI 1.36-2.24 or 8 days or more OR = 2.08; 95% CI 1.62-2.66). 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引用次数: 0
摘要
背景：疟疾是巴西亚马逊河外地区发病率较低的传染病。尽管如此，与该国流行区相比，该区域的死亡率较高。因此，本研究旨在分析亚马逊外地区疟疾住院（严重疟疾）的相关因素，以预防死亡。方法：采用病例对照设计，利用2011 - 2019年巴西法定疾病信息系统（Sinan）的数据和统一卫生系统（SIH/SUS）的住院记录。病例包括住院的疟疾患者，而对照包括未住院的疟疾通报。采用概率记录链接技术，并使用多重逻辑回归分析相关性，显著性水平为0.05。结果：确定的主要危险因素为：黑人或混血儿(or = 1.22；95% CI 1.04-1.43)，低教育程度(小学OR = 2.21；95% CI 1.78-2.75或高中or = 1.72；95% CI 1.39-2.13)，亚马逊地区以外的感染(亚马逊地区OR = 1.50；95% CI 1.15-1.96或国外or = 1.72；95% CI 1.28-2.32)，高寄生虫计数(501 ~ 10,000/mm3 OR = 1.51；95% CI 1.27 ~ 1.80, OR = 1.77；95% CI 2.87-1.96或高于100,000/mm3 or = 3.15；95% CI 2.20-4.50)和延迟治疗(症状出现3-7天后OR = 1.74；95% CI 1.36-2.24或8天以上or = 2.08；95% ci 1.62-2.66)。主动病例发现是保护因素(OR = 0.65；95% ci 0.54-0.78)。结论：延迟治疗仍然是发生严重疟疾的一个关键因素，导致高寄生虫率，并揭示了基于社会经济差异的获得医疗保健的不平等。前往亚马逊地区或其他国家旅行也构成挑战，需要加强旅行者健康战略并提高监测意识，以便及时怀疑和查明病例。
Factors associated with hospitalizations due to severe malaria in the non-endemic Brazilian region: a case-control study in the extra-Amazon Region from 2011 to 2019.
Background: Malaria is infectious disease with low occurrence in Brazil extra-Amazon Region. Despite this, higher lethality is observed in this region compared to the country's endemic area. Therefore, this study aimed to analyse factors associated with malaria hospitalizations (severe malaria) in the extra-Amazon Region, in order to prevent deaths.
Methods: A case-control design was used, utilizing data from the Brazilian Notifiable Diseases Information System (Sinan) and hospitalization records from the Unified Health System (SIH/SUS) from 2011 to 2019. Cases comprised hospitalized malaria patients, while controls included reported malaria notifications without hospitalization. Probabilistic record linkage techniques were employed, and associations were analysed using multiple logistic regression with a 0.05 significance level.
Results: The main risk factors identified were: Black or mixed-race ethnicity (OR = 1.22; 95% CI 1.04-1.43), low education (elementary school OR = 2.21; 95% CI 1.78-2.75 or high school OR = 1.72; 95% CI 1.39-2.13), infection outside the extra-Amazon Region (Amazon Region OR = 1.50; 95% CI 1.15-1.96 or abroad OR = 1.72; 95% CI 1.28-2.32), high parasite count (501 to 10,000/mm3 OR = 1.51; 95% CI 1.27-1.80, 10,001 to 100,000/mm3 OR = 1.77; 95% CI 2.87-1.96 or higher than 100,000/mm3 OR = 3.15; 95% CI 2.20-4.50) and delayed treatment (after 3-7 days symptoms onset OR = 1.74; 95% CI 1.36-2.24 or 8 days or more OR = 2.08; 95% CI 1.62-2.66). Active case detection was a protective factor (OR = 0.65; 95% CI 0.54-0.78).
Conclusions: Delayed treatment remains a key factor in the occurrence of severe malaria, leading to high parasitaemia and revealing inequalities in access to healthcare based on socioeconomic differences. Travel to the Amazon Region or other countries also poses a challenge, requiring strengthened traveller health strategies and increased surveillance awareness to promptly suspect and identify cases.
期刊介绍：
Malaria Journal is aimed at the scientific community interested in malaria in its broadest sense. It is the only journal that publishes exclusively articles on malaria and, as such, it aims to bring together knowledge from the different specialities involved in this very broad discipline, from the bench to the bedside and to the field.
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