Pain in Malaria: An Assessment of Its Prevalence, Characteristics and Determinants in Ibadan, Nigeria

Abstract

Morbidity and mortality due to malaria in sub-Sahara Africa remains unacceptably high, slowing socioeconomic development 
in endemic communities. Pain is one reason why malaria-patients seek medical attention. However, pain due to malaria is often 
ignored, poorly evaluated and virtually un-studied. This study explored this pain among outpatients in Ibadan, Nigeria. This 
facility-based, cross-sectional survey conducted in Ibadan examined seven-hundred out-patients, aged ≥6years, with acuteuncomplicated-malaria. They were evaluated for the presence, quality, intensity and effects of pain using validated instruments 
incorporating the category and Wong-Baker faces scales. Data were summarized, tested for association at α=0.05 and a logistic 
regression model of covariates fitted to predict the risk of pain. Respondents’ mean age was 33.0±16.1years, 12.7% children, 
66.6% females and 72.3% had “malaria pain”. The head (66.0% vs.72.8%), general muscular sites (17.0% vs.39.5%), abdomen 
(37.7% vs.11.4%) and joints (5.7% vs.17.0%) were the commonest localization of malaria-pain while, the character was aching 
in 91.9% vs.90.6%, intermittent pattern in 71.2% vs. 64.7% among children versus adults, respectively. At peak, pain-intensity 
was rated moderate and severe in 47.2% and 23.4% of respondents, able to completely interrupt work/school in 4.3%. 
Respondents’ gender, age-group, packed cell volume, using any antimalarial and non-usage of Artemisinin-based Combination 
Therapy had significant association with experiencing malaria-pain. This study highlighted pain as a significant symptom of 
malaria with higher risk in children, males, persons with hematocrit <30% and those not using artemisinin-based combination 
therapy. More attention needs to be paid to the assessment and effective treatment of malaria-pain.