Factors Associated With Resistance to In-Hospital Treatment of Malaria in Angolan Patients

Abstract

Background: Malaria is a public health problem, particularly in low- and middle-income countries. In Angola, it is the leading cause of death, morbidity, and absenteeism from work and school. Objective: To evaluate the social and clinical factors associated with resistance to in-hospital treatment. Methodology: A prospective analytical cross-sectional study with a quantitative approach was conducted including 220 patients with malaria. Results: Of the 220 patients enrolled, the majority were between 21 and 40 years old (72.7%), male (53.6%), of peri-urban areas (47.7%), employees (46.4%), and with high parasitemia levels (57.7%). Of the remaining hospitalized patients (61.4%), 20.9% were resistant to treatment. The resistance risk was higher in patients over 40 years [OR: 5.91 (95% CI: 0.76-45.7), P = .088], from rural regions [OR: 2.48 (95% CI: 0.95-6.48), P = .064], that were unemployed [OR: 1.06 (95% CI: 0.52-2.15), P = .859], presenting high parasitemia [OR: 1.95 (95% CI: 1.02-3.75), P = .043] and who remained hospitalized [OR: 5.28 (95% CI: 0.63-43.1), P = .121]. The risk to develop resistance was lower in patients that were students [OR: 0.04 (95% CI: 0.01-0.37), P = .004], patients who were treated with dipyrone [OR: 0.06 (95% CI: 0.01-0.24), P < .001], metoclopramide [OR: 0.25 (95% CI: 0.09-0.67), P = .006] and ciprofloxacin [OR: 0.22 (95% CI: 0.11-0.44), P < .001]. Conclusion: Treatment with antimalarial drugs as well as the use of adjuvants such as dipyrone, metoclopramide, ciprofloxacin, and diazepam can reduce the chances of developing resistance to malaria treatment, however, it is necessary to carry out further in-depth studies.