Outcomes of severe malaria and its clinical features in Gabonese children

Abstract

BackgroundMalaria remains one of the deadliest diseases in the tropic. Its severe form represents a major public health concern in sub-Saharan Africa. The study aimed to describe and analyze clinical features and outcomes of severe malaria in children from Libreville.MethodsMedical records (March 2018- to December 2019) from the emergency ward of the “Mother and Child University Hospital” were analyzed. Children hospitalized for malaria who met one or more criteria of the severe form rating according to the WHO guideline were included in the study.ResultsOne hundred thirty-four children (134) children were included in the study. All children were anemic with 44% of children showing severe anemia. Thirty-three percent (33%) of admitted children were comatose or agonizing. The most frequent form of severe malaria was cerebral malaria with 101 cases (75.4%). The death rate was 18.6% (25/134). Twenty-one (21) children (84% of the deceased) died within the first 48 hours of hospitalization. In the subgroup of the deceased children, hepatomegaly was significantly more frequent (88%) than in the subgroup of those who survived (2.8%) (χ2 = 97.38; p<0.0001); Leukocytosis was more pronounced in the subgroup of the children under one year p<0.0001). Deep acidotic breathing was more frequent in cerebral malaria (χ2 = 5.4; p = 0.02).ConclusionsData revealed a high malaria-associated fatality rate. Cerebral malaria was the most frequent severe form of malaria. The relatively high frequency of comatose and/or agonizing children on admission raises the question of parents’ awareness and poor initial assessment of children’s clinical state.

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“…Hepatosplenomegaly was the frequent clinical finding in severe malaria and indicated a bad prognosis. 72,73 Smaller spleen indices were observed in CDDP and the mixture groups, indicating that platinum drugs could lessen splenomegaly. 10f, CDDP, and the mixture all obviously lessened the hepatomegaly.…”

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“…In Gabon, the main signs of severe malaria in children are severe anemia, neurological complications, hypoglycemia and respiratory distress. In children under 5 years of age, severe anemia is the most frequent clinical sign in severe forms [12,[14][15][16]. Previous studies have also reported that older children (and even adults) who would normally have acquired immunity may develop severe forms of the disease [15,17].…”

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“…These findings were within the leading clinical manifestations of severe malaria documented within and outside Nigeria. 20,24 In addition, cerebral malaria in the presence of acute kidney injury has the highest case fatality rate of 57%. Part of the pathogenic mechanisms during cerebral malaria include increased cytokines release, brain edema, and damage with an increased risk of death.…”