Evaluation of the Health-related Quality of Life of Children with Dengue and Malaria in Western Kenya

Background: Malaria and dengue are leading causes of mortality and morbidity in sub-Saharan Africa. Although acute disease symptoms can be clinically recognized, the effects on daily living associated with disease due to either or both infections are still unclear, especially in a pediatric population where disease burden is the greatest. The goal of this study was to investigate the effect of dengue virus (DENV) and/or malaria infection on health-related quality of life (HrQoL) in children in Western Kenya.

Methods: We used the Pediatric Quality of Life Inventory (PedsQL), a modular instrument, to assess health-related quality of life (HrQoL) among children, aged 2-18 (n = 171), who presented with fever to one of two health centers in Western Kenya. The PedsQL questionnaires were administered to subjects and their parents in their native Luo language, and then transformed onto a 0-100 scale with higher scores indicating better HrQoL. Blood samples from child with acute febrile illness were assayed for the presence of malaria parasitemia by light microscopy or by rapid diagnostic testing cards, and for DENV viremia by RT-PCR. Cases of DENV infection were also identified based on anti-DENV IgG seroconversion by ELISA between blood samples obtained at time of presentation and at one month follow up.

Results: The mean PedsQL score for all febrile children was 87.3 (95% CI 85.6 to 89.1) at the time of presentation. By the one-month follow up visit, the mean score increased to 94.92 (95% CI 93.5 to 96.4, p<0.001 by paired T-test). The increases by the convalescent visit were also observed for groups of children who had malaria (mean score 88.5 to 96.1, p<0.001) or who had febrile illness that was neither malaria nor DENV (mean score 87.7 to 96.3, p<0.001). For children who were infected with DENV, or who had concurrent infection with both DENV and malaria, the increase in scores was less pronounced; the mean score increased from 84.7 to 91.1 (p=0.3) and 83.6 to 90.7 (p=0.07) for children with DENV mono-infection or DENV/malaria co-infection, respectively.

Conclusion: Data are continuing to be collected as part of our ongoing study. However slower recovery in the PedsQL scores of DENV-infected children may indicate that consequences of DENV infection may have longer-lasting effects than previously believed.