African children with malaria in an area of intense Plasmodium falciparum transmission: features on admission to the hospital and risk factors for death.

Abstract

Abstract. Malaria remains the most important parasitic cause of mortality in humans. Its presentation is thought to vary according to the intensity of Plasmodium falciparum transmission. However, detailed descriptions of presenting features and risk factors for death are only available from moderate transmission settings. Such descriptions help to improve case management and identify priority research areas. Standardized systematic procedures were used to collect clinical and laboratory data on 6,624 children admitted to hospital over a 1-year period in an intensely malarious part of Tanzania. Frequencies of signs and symptoms were calculated and their association with a fatal outcome was assessed using multivariate logistic regression. There were 72 deaths among 2,432 malaria cases (case fatality rate [CFR] ϭ 3.0%); 44% of the cases and 54% of the deaths were in individuals less than 1 year of age. There was no association between level of parasitemia and CFR. Increased risk of dying was independently found in all children with hypoglycemia (odds ratio [OR] ϭ 6.7, 95% confidence interval [CI] ϭ 3.9-11.7), in children 1-7 months of age with tachypnea (OR ϭ 8.8, 95% CI ϭ 2.6-30.5) and dehydration (OR ϭ 5.0, 95% CI ϭ 1.9-14.2), and in children 8 months to 4 years of age with chest indrawing (OR ϭ 4.7, 95% CI ϭ 2.0-11.2) and inability to localize a painful stimulus (OR ϭ 6.9, 95% CI ϭ 2.9-16.5). Children in the bottom quartile of weight-for-age were more likely to die (OR ϭ 2.1, 95% CI ϭ 1.3-3.5). Eight percent of the malaria cases had severe anemia (packed cell volume Ͻ 15%) but 24% received a blood transfusion. The epidemiology of malaria disease may be more complex than previously thought. Improved case management in a wide variety of health facilities may result from adequate identification and treatment of dehydration and hypoglycemia. Transfusion-requiring anemia is a major problem and sustainable, effective preventive measures are urgently needed.More than half of the world's population lives in areas endemic for Plasmodium falciparum malaria, resulting in more than 400 million clinical cases and between one and three million deaths every year. 1 Young children living in sub-Saharan Africa carry the largest part of this burden. 2 Although the epidemiology of P. falciparum infection has been well described in a variety of settings, the description of malaria as a life-threatening disease is less complete. Such descriptions can improve case management by identifying children at highest risk of dying; focusing scarce resources on such patients may reduce case fatality rates. Furthermore, these studies provide valuable insights into underlying pathophysiologic processes.Common manifestations of severe malaria in children include cerebral malaria and severe anemia. The relative importance of each presentation is thought to vary according to the intensity of transmission, with severe anemia being increasingly important as transmission intensity increases and cerebral malaria more common at lower transmission inten...

Characterization and Treatment of Severe Malaria in Hospitalized Children at a Ghanaian District Hospital

“…This observation is consistent with reports from Tanzania [13], northern Ghana [8] and Gabon [5]. Although males may indeed be more liable to develop severe malaria, sociological reasons often suggest that this trend is indicative of household-level gender bias in treatment-seeking behaviour for male children.…”

Characteristics of severe anemia and its association with malaria in young children of the Kassena-Nankana District of northern Ghana.

“…13,16 For this reason, hospital-based studies are unsuited and unable to detect important natural differences between boys and girls. Following this rationale, we hypothesized a greater proportion and severity of anemia among infant girls and are impressed by random survey data indicating just the opposite.…”

Increased circulating interleukin (IL)-23 in children with malarial anemia: In vivo and in vitro relationship with co-regulatory cytokines IL-12 and IL-10

“…Anemia is a common cause of childhood morbidity and mortality in sub-Saharan Africa occurring in 30-60% of children less than 5 years of age [1,2] and accounting for more than half of all hospital pediatric mortality [3,4]. One of the leading causes of pediatric anemia in sub-Saharan Africa is Plasmodium falciparum malaria which can culminate in life-threatening severe malarial anemia (SMA) [3,5,6].…”