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Distinguishing Malaria from Severe Pneumonia among Hospitalized Children who Fulfilled Integrated Management of Childhood Illness Criteria for Both Diseases: A Hospital-Based Study in Mozambique
Quique Bassat
Quique Bassat
Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique; Pediatric Radiology Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain; Indonesia Country Office World Health Organization, Jakarta, Indonesia
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Sónia Machevo
Sónia Machevo
Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique; Pediatric Radiology Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain; Indonesia Country Office World Health Organization, Jakarta, Indonesia
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Cristina O'Callaghan-Gordo
Cristina O'Callaghan-Gordo
Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique; Pediatric Radiology Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain; Indonesia Country Office World Health Organization, Jakarta, Indonesia
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Betuel Sigaúque
Betuel Sigaúque
Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique; Pediatric Radiology Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain; Indonesia Country Office World Health Organization, Jakarta, Indonesia
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Luís Morais
Luís Morais
Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique; Pediatric Radiology Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain; Indonesia Country Office World Health Organization, Jakarta, Indonesia
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Núria Díez-Padrisa
Núria Díez-Padrisa
Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique; Pediatric Radiology Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain; Indonesia Country Office World Health Organization, Jakarta, Indonesia
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Josep L. Ribó
Josep L. Ribó
Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique; Pediatric Radiology Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain; Indonesia Country Office World Health Organization, Jakarta, Indonesia
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Inácio Mandomando
Inácio Mandomando
Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique; Pediatric Radiology Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain; Indonesia Country Office World Health Organization, Jakarta, Indonesia
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Tacilta Nhampossa
Tacilta Nhampossa
Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique; Pediatric Radiology Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain; Indonesia Country Office World Health Organization, Jakarta, Indonesia
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Edgar Ayala
Edgar Ayala
Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique; Pediatric Radiology Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain; Indonesia Country Office World Health Organization, Jakarta, Indonesia
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Sergi Sanz
Sergi Sanz
Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique; Pediatric Radiology Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain; Indonesia Country Office World Health Organization, Jakarta, Indonesia
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Martin Weber
Martin Weber
Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique; Pediatric Radiology Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain; Indonesia Country Office World Health Organization, Jakarta, Indonesia
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Anna Roca
Anna Roca
Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique; Pediatric Radiology Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain; Indonesia Country Office World Health Organization, Jakarta, Indonesia
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Pedro L. Alonso
Pedro L. Alonso
Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique; Pediatric Radiology Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain; Indonesia Country Office World Health Organization, Jakarta, Indonesia
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Malaria and severe pneumonia in hospitalized young children may show striking clinical similarities, making differential diagnosis challenging. We investigated ways to increase diagnostic accuracy in patients hospitalized with clinical symptoms compatible with malaria and severe pneumonia, in an area with high a prevalence of infection with human immunodeficiency virus. A total of 646 children admitted at the Manhiça District Hospital in Manhiça, Mozambique who met the World Health Organization clinical criteria for severe pneumonia and malaria were recruited for 12 months and thoroughly investigated to ascertain an accurate diagnosis. Although symptom overlap between malaria and severe pneumonia was frequent among hospitalized children, true disease overlap was uncommon. Clinical presentation and laboratory determinations were ineffective in reliably distinguishing between the two diseases. Infection with human immunodeficiency virus differentially influenced the epidemiology and clinical presentation of these two infectious diseases, further challenging their discrimination on clinical grounds, and having a greater impact on the current burden and prognosis of severe pneumonia.
Author Notes
Financial support: This study was supported by a grant from the World Health Organization (WHO-C6-181-489). The Centro de Investigaçaõ em Saúde da Manhiça received financial support from the Spanish Agency for International Cooperation. Quique Bassat and Anna Roca were supported at the time of the study by the Spanish Ministry of Science and Innovation (FIS: Contrato post Formación Sanitaria Especializada, Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos III, ref. CM05/00134) and Ramon y Cajal (RYC2008-02777), respectively.
Disclosure: None of the authors has any conflicts of interests.
Authors' addresses: Quique Bassat, Cristina O'Callaghan-Gordo, Núria Díez-Padrisa, Edgar Ayala, Sergi Sanz, Anna Roca, and Pedro L. Alonso, Centre de Recerca en Salut Internacional de Barcelona, Hospital Clínic, Universitat de Barcelona, Rosselló 132, 4art, 08036 Barcelona, Spain, E-mails: quique.bassat@cresib.cat, cristina.ocallaghan@cresib.cat, nuria.diez@cresib.cat, edgar_am12@hotmail.com, ssanz@clinic.ub.es, aroca@mrc.gm, and palonso@clinic.ub.es. Sónia Machevo, Betuel Sigaúque, Luís Morais, Inácio Mandomando, and Tacilta Nhampossa, Centro de Investigaçaõ em Saúde da Manhiça, Rúa 12 Vila da Manhiça, CP1929, Maputo, Mozambique, E-mails: sonia.machevo@manhica.net, betuel.sigauque@manhica.net, musukhamorais@yahoo.com.br, inacio.mandomando@gmail.com, and taciltanha@yahoo.com. Josep L. Ribó, Hospital Universitari Sant Joan de Déu, 08950 Esplugues de Llobregat, Barcelona, Spain, E-mail: jlribo@hsjdbcn.org. Martin Weber, World Health Organization, Indonesia Country Office, Bina Mulia 1 Building, Jalan HR Rasuna Said Kav. 10, Jakarta 12950, Indonesia, E-mail: weberm@who.or.id.
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