Diabetes and metabolic syndrome in adults with malaria and associations with severe disease: results from two tertiary hospitals in Cameroon

Abstract

BACKGROUND: The prevalence of lifestyle-associated diseases is increasing in sub-Saharan Africa. This study investigated the prevalence of metabolic co-morbidities in adults with malaria and whether type 2 diabetes, obesity, and metabolic syndrome (Met-S) affect the severity of malaria in adults living in a malaria-endemic setting. METHODS: We conducted a cross-sectional study with prospective inclusion of patients at two tertiary-level public hospitals in Bafoussam and Dschang (West Region, Cameroon). Adults (≥ 21 years) diagnosed with malaria were included. Malaria severity was determined following the WHO criteria. All patients were assessed for diabetes, obesity, and Met-S, according to the International Diabetes Federation. Additional host factors investigated included age, sex, HIV infection, sickle cell trait and blood group. Multivariable logistic regression was used to assess potential associations with severe malaria. RESULTS: Among 289 adults diagnosed with P. falciparum malaria, 120 (41.6%) fulfilled at least one criterion for severe malaria. Diabetes was found in 26/120 (21.7%) of patients with severe and 10/169 (6.0%) with non-severe malaria (p < 0.001). Met-S was diagnosed in 39/120 (32.5%) severe and 27/166 (16.3%) non-severe cases, respectively (p = 0.001). Obesity was similarly detected in severe (23/103; 22.3%) and non-severe cases (34/148; 23.0%). In multivariable analyses, diabetes (aOR = 3.24; 95%CI, 1.38-7.62) and Met-S (aOR = 3.18; 95%CI, 1.60-6.37) were independently associated with severe malaria. CONCLUSION: A high prevalence of diabetes and metabolic comorbidities was found among adults diagnosed with malaria in hospital settings in an endemic area. Diabetes and metabolic syndrome, but not obesity alone, were identified as risk factors for severe malaria. Investigation for diabetes should be considered in adults with severe malaria.